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Gorostegui M, Muñoz JP, Perez-Jaume S, Simao-Rafael M, Larrosa C, Garraus M, Salvador N, Lavarino C, Krauel L, Mañe S, Castañeda A, Mora J. Management of High-Risk Neuroblastoma with Soft-Tissue-Only Disease in the Era of Anti-GD2 Immunotherapy. Cancers (Basel) 2024; 16:1735. [PMID: 38730688 PMCID: PMC11083939 DOI: 10.3390/cancers16091735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Neuroblastoma presents with two patterns of disease: locoregional or systemic. The poor prognostic risk factors of locoregional neuroblastoma (LR-NB) include age, MYCN or MDM2-CDK4 amplification, 11q, histology, diploidy with ALK or TERT mutations, and ATRX aberrations. Anti-GD2 immunotherapy has significantly improved the outcome of high-risk (HR) NB and is mostly effective against osteomedullary minimal residual disease (MRD), but less so against soft tissue disease. The question is whether adding anti-GD2 monoclonal antibodies (mAbs) benefits patients with HR-NB compounded by only soft tissue. We reviewed 31 patients treated at SJD for HR-NB with no osteomedullary involvement at diagnosis. All tumors had molecular genetic features of HR-NB. The outcome after first-line treatment showed 25 (80.6%) patients achieving CR. Thirteen patients remain in continued CR, median follow-up 3.9 years. We analyzed whether adding anti-GD2 immunotherapy to first-line treatment had any prognostic significance. The EFS analysis using Cox models showed a HR of 0.20, p = 0.0054, and an 80% decrease in the risk of relapse in patients treated with anti-GD2 immunotherapy in the first line. Neither EFS nor OS were significantly different by CR status after first-line treatment. In conclusion, adding treatment with anti-GD2 mAbs at the stage of MRD helps prevent relapse that unequivocally portends poor survival.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jaume Mora
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (M.G.); (J.P.M.); (M.S.-R.); (C.L.); (M.G.); (N.S.); (C.L.); (L.K.); (S.M.); (A.C.)
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2
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Les essais qui changent les pratiques : le point en 2022. Cancer Radiother 2022; 26:823-833. [DOI: 10.1016/j.canrad.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
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Lv Z, Yu Y, Luo Y, Lin S, Xiang X, Mao X, Cheng S. Long-term survival outcomes of pediatric adrenal malignancies: An analysis with the upstaged SEER registry during 2000-2019. Front Endocrinol (Lausanne) 2022; 13:977105. [PMID: 36171902 PMCID: PMC9511147 DOI: 10.3389/fendo.2022.977105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the clinicopathological characteristics and long-term survival outcomes of pediatric adrenal malignancies. METHOD This study retrospectively analyzed children with pathologically confirmed pediatric adrenal malignancies from Surveillance, Epidemiology, and End Results Database from 2000 to 2019. Kaplan-Meier curve was used to assess the overall survival (OS) and cancer-special survival (CSS), and the Log-Rank method was used to calculate statistical differences. Cox proportional hazards model and Fine-and-Grey model were used to calculate the hazard ratio (HR) of all-cause mortality risk and the sub-distribution HR (sHR) of disease-specific mortality risk, respectively, and their corresponding 95% confidence intervals (CI). RESULTS 1601 children were included in the study in which 1335 (83.4%) neuroblastoma, 151 (9.4%) ganglioneuroblastoma, 89 (5.6%) adrenocortical carcinoma, and 26 (1.6%) were diagnosed with other types malignancies. Metastatic disease accounted for the largest proportion (69.3%), and the proportion of metastases diagnosed by neuroblastoma was higher than that of adrenocortical carcinoma and ganglioneuroblastoma (73.9% vs. 45.7% vs. 47.2%). The 5-year OS and CSS of all cohort were 69.5% and 70.5%, respectively. Adrenal cortical carcinoma had the worst prognosis, with 5-year OS and CSS of 52.5% and 53.1%, respectively. Patients in recent years had no better OS and CSS than in previous years at diagnosis. The tumor stage remained the main prognostic predictor. Compared to metastatic adrenal tumors, the risk of all-cause mortality (adjusted HR: 0.12, 95% CI: 0.06-0.25, P < 0.001) and the risk of disease-specific mortality (adjusted sHR: 0.11, 95% CI: 0.05-0.25, P<0.001) was significantly lower for patients with localized diseases. Additionally, higher age, adrenal cortical carcinoma, and lack of complete tumor resection are independent risk factors for poor prognosis. Furthermore, it was found that the prognosis of patients who received chemotherapy was worse than those who did not, mainly because the former mostly had metastasis at the presentation and complete resection of the tumor cannot be achieved. CONCLUSION The clinicopathological characteristics of pediatric adrenal malignancies have not changed significantly in the past two decades, while the prognosis of patients has improved. Early diagnosis of disease and complete resection of local tumors are the keys to improving prognosis.
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Affiliation(s)
- Zemin Lv
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Yunyun Yu
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Yangmei Luo
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Song Lin
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Xuang Xiang
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Xiaowen Mao
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
- *Correspondence: Xiaowen Mao, ; Shigang Cheng,
| | - Shigang Cheng
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
- *Correspondence: Xiaowen Mao, ; Shigang Cheng,
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Laprie A, Bernier V, Padovani L, Martin V, Chargari C, Supiot S, Claude L. Guide for paediatric radiotherapy procedures. Cancer Radiother 2021; 26:356-367. [PMID: 34969622 DOI: 10.1016/j.canrad.2021.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A third of children with cancer receive radiotherapy as part of their initial treatment, which represents 800 paediatric irradiations per year in France carried out in 15 specialized centres approved on the recommendations of the French national cancer institute in decreasing order of frequency, the types of cancer that require irradiation are: brain tumours, neuroblastomas, Ewing's sarcomas, Hodgkin's lymphomas, soft tissue sarcomas including rhabdomyosarcomas, and nephroblastomas. The treatment guidelines follow the recommendations of the French society for childhood cancers (SFCE) or the French and European prospective protocols. The therapeutic indications, the technical and/and ballistic choices of complex cases are frequently discussed during bimonthly paediatric radiotherapy technical web-conferences. All cancers combined, overall survival being 80%, long-term toxicity logically becomes an important concern, making the preparation of treatments complex. The irradiation methods include all the techniques currently available: 3D conformational irradiation, intensity modulation radiation therapy, irradiation under normal or hypofractionated stereotaxic conditions, brachytherapy and proton therapy. We present the update of the recommendations of the French society for radiation oncology on the indications, the technical methods of realization and the organisation and the specificities of paediatric radiation oncology.
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Affiliation(s)
- A Laprie
- Département d'oncologie radiothérapie, Institut universitaire du cancer de Toulouse-Oncopole (IUCT-oncopole), université Paul-Sabatier Toulouse III, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
| | - V Bernier
- Département d'oncologie radiothérapie, Institut de cancérologie de Lorraine centre Alexis-Vautrin, 6, avenue de Bourgogne, CS 30519, 54519 Vandœuvre-lès-Nancy cedex, France
| | - L Padovani
- Département de cancérologie radiothérapie, CHU, 13000 Marseille, France; Université Aix-Marseille, 13000 Marseille, France
| | - V Martin
- Département de cancérologie radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - C Chargari
- Département d'oncologie radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France; Service de santé des armées, 75000 Paris, France
| | - S Supiot
- Département de radiothérapie, Institut de cancérologie de l'Ouest (ICO) centre René-Gauducheau, 44800 Saint-Herblain, France; Université de Nantes, 44000 Nantes, France
| | - L Claude
- Département d'oncologie radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France
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Biko DM, Lichtenberger JP, Rapp JB, Khwaja A, Huppmann AR, Chung EM. Mediastinal Masses in Children: Radiologic-Pathologic Correlation. Radiographics 2021; 41:1186-1207. [PMID: 34086496 DOI: 10.1148/rg.2021200180] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Most pediatric masses in the chest are located in the mediastinum. These masses are often initially detected incidentally on chest radiographs in asymptomatic children, although some patients may present with respiratory symptoms. At chest radiography, the mediastinum has been anatomically divided into anterior, middle, and posterior compartments. However, with the International Thymic Malignancy Interest Group classification scheme, which is based on cross-sectional imaging findings, the mediastinum is divided into prevascular, visceral, and paravertebral compartments. In the prevascular compartment, tumors of thymic origin, lymphomas, germ cell tumors, and vascular tumors are encountered. In the visceral compartment, lymphadenopathy and masses related to the foregut are seen. In the paravertebral compartment, neurogenic tumors are most common. Using the anatomic location in combination with knowledge of the imaging and pathologic features of pediatric mediastinal masses aids in accurate diagnosis of these masses to guide treatment and management decisions. An invited commentary by Lee and Winant is available online. ©RSNA, 2021.
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Affiliation(s)
- David M Biko
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
| | - John P Lichtenberger
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
| | - Jordan B Rapp
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
| | - Asef Khwaja
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
| | - Alison R Huppmann
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
| | - Ellen M Chung
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
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Long-Term Outcome and Role of Biology within Risk-Adapted Treatment Strategies: The Austrian Neuroblastoma Trial A-NB94. Cancers (Basel) 2021; 13:cancers13030572. [PMID: 33540616 PMCID: PMC7867286 DOI: 10.3390/cancers13030572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/08/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Neuroblastoma, the most common extracranial malignancy of childhood, shows a highly variable course of disease ranging from spontaneous regression or maturation into a benign tumor to an aggressive and intractable cancer in up to 60% of patients. To adapt treatment intensity, risk staging at diagnosis is of utmost importance. The A-NB94 trial was the first in Austria to stratify therapy intensity according to tumor staging, patient’s age, and MYCN amplification status, the latter being a biologic marker turning otherwise low-risk tumors into high-risk disease. Recent publications showed a prognostic impact of various genomic features including segmental chromosomal aberrations (SCAs). We retrospectively investigated the relevance of SCAs within this risk-adapted treatment strategy. The A-NB94 approach resulted in an excellent long-term survival for the majority of patients with acceptable long-term morbidity. An age- and stage-dependent frequency of SCAs was confirmed and SCAs should always be considered in future treatment decision making processes. Abstract We evaluated long-term outcome and genomic profiles in the Austrian Neuroblastoma Trial A-NB94 which applied a risk-adapted strategy of treatment (RAST) using stage, age and MYCN amplification (MNA) status for stratification. RAST ranged from surgery only to intensity-adjusted chemotherapy, single or multiple courses of high-dose chemotherapy (HDT) followed by autologous stem cell rescue depending on response to induction chemotherapy, and irradiation to the primary tumor site. Segmental chromosomal alterations (SCAs) were investigated retrospectively using multi- and pan-genomic techniques. The A-NB94 trial enrolled 163 patients. Patients with localized disease had an excellent ten-year (10y) event free survival (EFS) and overall survival (OS) of 99 ± 1% and 93 ± 2% whilst it was 80 ± 13% and 90 ± 9% for infants with stage 4S and for infants with stage 4 non-MNA disease both 83 ± 15%. Stage 4 patients either >12 months or ≤12 months but with MNA had a 10y-EFS and OS of 45 ± 8% and 47 ± 8%, respectively. SCAs were present in increasing frequencies according to stage and age: in 29% of localized tumors but in 92% of stage 4 tumors (p < 0.001), and in 39% of patients ≤ 12 months but in 63% of patients > 12 months (p < 0.001). RAST successfully reduced chemotherapy exposure in low- and intermediate-risk patients with excellent long-term results while the outcome of high-risk disease met contemporary trials.
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Wang Z, Cheng H, Xu H, Yu X, Sui D. A five-gene signature derived from m6A regulators to improve prognosis prediction of neuroblastoma. Cancer Biomark 2020; 28:275-284. [PMID: 32176634 DOI: 10.3233/cbm-191196] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE N6-methyladenosine (m6a) is the most abundant form of methylated modification in eukaryotic mRNA. However, the role of m6A-related genes in neuroblastoma (NB), one of the most common paediatric malignant tumours, is not well known. This study aimed to determine the prognostic role of m6A-related genes in neuroblastoma. METHODS We analysed the expression of 20 published m6A methylation regulators in 498 patients with NB from the Gene Expression Omnibus database. To determine the independent prognostic factors, we used univariate Cox analysis, the least absolute shrinkage and selection operator (LASSO) regression. The multivariate Cox analysis was used to construct a prognostic risk prediction model. 120 NB tissues from "Therapeutically Applicable Research To Generate Effective Treatments" (TARGET ) database was used to test the prognostic value. Gene set enrichment analysis was performed to discover the potential biological function of the m6A signature. RESULTS The risk prediction model consisted of five genes (METT14, WTAP, HNRNPC, YTHDF1 and IGF2BP2). The receiving operating characteristic curve showed the high exactitude of the risk model. Cox regression analysis revealed that the risk model was an independent prognostic factor of overall survival. These results were reproduced using another published independent dataset. Further functional enrichment analysis suggested the involvement of the 5-gene signature in several malignancies. CONCLUSION The five m6A regulatory genes identified in this study enable clinical prognosis of NB and may serve as novel therapeutic targets for NB.
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Affiliation(s)
- Zhichao Wang
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin, China
- Department of Pediatric Surgery, First Hospital of Jilin University, Changchun, Jilin, China
| | - Huiyan Cheng
- Department of Gynecology and Obstetrics, First Hospital of Jilin University, Changchun, Jilin, China
| | - Huali Xu
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin, China
| | - Xiaofeng Yu
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin, China
| | - Dayun Sui
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin, China
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8
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Elhaj NOY, Nugud FA, Abuagla OA, Mohamedani AA, Haroun HM. Neuroblastoma in Sudan: experience of a single institute. Sudan J Paediatr 2020; 20:122-125. [PMID: 32817732 DOI: 10.24911/sjp.106-1570515379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Neuroblastoma (NBL) is the most common malignant solid extracranial tumour in children. It accounts for about 8%-10% of overall childhood malignancies in developed countries and only 1%-3% in developing countries. We aim to study the clinical presentation and outcome of NBL in children treated at the National Cancer Institute (NCI), University of Gezira, Wad Madani, Sudan. This is a retrospective, descriptive, hospital-based study, where patients' records were reviewed from the years 2004-2015. During this period, 38 paediatric patients were treated in the Paediatric Oncology Unit at the NCI, accounting for about 4% of the overall childhood malignancies. Of them, 24 (63%) were males and 14 (37%) were females with a ratio of 1.7: 1. The age at presentation ranged between 2 months and 7 years with a mean age at the presentation of 3 years. Twenty-nine (76%) of them were classified as high-risk disease, no one received high-dose chemotherapy, 33(87%) died and only 5 (13%) achieved complete remission. This study reflects the poor outcome of NBL among Sudanese children which can be explained by the late presentation of the patients, lack of the diagnostic modalities and lack of the sophisticated treatment modalities for high-risk NBL.
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Affiliation(s)
| | | | | | | | - Huda Mohamed Haroun
- Department of Paediatrics, Faculty of Medicine, University of Gezira, Wad Madani, Sudan
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9
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van Wezel EM, van Zogchel LMJ, van Wijk J, Timmerman I, Vo NK, Zappeij-Kannegieter L, deCarolis B, Simon T, van Noesel MM, Molenaar JJ, van Groningen T, Versteeg R, Caron HN, van der Schoot CE, Koster J, van Nes J, Tytgat GAM. Mesenchymal Neuroblastoma Cells Are Undetected by Current mRNA Marker Panels: The Development of a Specific Neuroblastoma Mesenchymal Minimal Residual Disease Panel. JCO Precis Oncol 2019; 3:1800413. [PMID: 34036221 PMCID: PMC8133311 DOI: 10.1200/po.18.00413] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2019] [Indexed: 12/29/2022] Open
Abstract
Patients with neuroblastoma in molecular remission remain at considerable risk for disease recurrence. Studies have found that neuroblastoma tissue contains adrenergic (ADRN) and mesenchymal (MES) cells; the latter express low levels of commonly used markers for minimal residual disease (MRD). We identified MES-specific MRD markers and studied the dynamics of these markers during treatment. PATIENTS AND METHODS Microarray data were used to identify genes differentially expressed between ADRN and MES cell lines. Candidate genes were then studied using real-time quantitative polymerase chain reaction in cell lines and control bone marrow and peripheral blood samples. After selecting a panel of markers, serial bone marrow, peripheral blood, and peripheral blood stem cell samples were obtained from patients with high-risk neuroblastoma and tested for marker expression; survival analyses were also performed. RESULTS PRRX1, POSTN, and FMO3 mRNAs were used as a panel for specifically detecting MES mRNA in patient samples. MES mRNA was detected only rarely in peripheral blood; moreover, the presence of MES mRNA in peripheral blood stem cell samples was associated with low event-free survival and overall survival. Of note, during treatment, serial bone marrow samples obtained from 29 patients revealed a difference in dynamics between MES mRNA markers and ADRN mRNA markers. Furthermore, MES mRNA was detected in a higher percentage of patients with recurrent disease than in those who remained disease free (53% v 32%, respectively; P = .03). CONCLUSION We propose that the markers POSTN and PRRX1, in combination with FMO3, be used for real-time quantitative polymerase chain reaction-based detection of MES neuroblastoma mRNA in patient samples because these markers have a unique pattern during treatment and are more prevalent in patients with poor outcome. Together with existing markers of MRD, these new markers should be investigated further in large prospective studies.
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Affiliation(s)
- Esther M van Wezel
- Sanquin Research Amsterdam, the Netherlands.,Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Lieke M J van Zogchel
- Sanquin Research Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jalenka van Wijk
- Sanquin Research Amsterdam, the Netherlands.,Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ilse Timmerman
- Sanquin Research Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | | | - Thorsten Simon
- Children's Hospital University of Cologne, Cologne, Germany
| | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jan J Molenaar
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Rogier Versteeg
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Huib N Caron
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Jan Koster
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Johan van Nes
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Godelieve A M Tytgat
- Amsterdam University Medical Center, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Arumugam S, Manning-Cork NJ, Gains JE, Boterberg T, Gaze MN. The Evidence for External Beam Radiotherapy in High-Risk Neuroblastoma of Childhood: A Systematic Review. Clin Oncol (R Coll Radiol) 2018; 31:182-190. [PMID: 30509728 DOI: 10.1016/j.clon.2018.11.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/27/2018] [Indexed: 12/15/2022]
Abstract
AIMS External beam radiotherapy is widely used in various ways in the management of neuroblastoma. Despite extensive clinical experience, the precise role of radiotherapy in neuroblastoma remains unclear. The purpose of this systematic review was to survey the published literature to identify, without bias, the evidence for the clinical effectiveness of external beam radiotherapy as part of the initial multimodality treatment of high-risk neuroblastoma. We considered four areas: treatment of the tumour bed and residual primary tumour, identification of any dose-response relationship, treatment of metastatic sites, identification of any technical advances that may be beneficial. We also aimed to define uncertainties, which may be clarified in future clinical trials. MATERIALS AND METHODS Bibliographic databases were searched for neuroblastoma and radiotherapy. Reviewers assessed 1283 papers for inclusion by title and abstract, with consensus achieved through discussion. Data extraction on 57 included papers was carried out by one reviewer and checked by another. Studies were assessed for their level of evidence and risk of bias, and a descriptive analysis of data was carried out. RESULTS Fifteen papers provided some evidence that radiotherapy to the tumour bed and residual tumour may possibly be of value. However, there is a significant risk of bias and no evidence that all subgroups will benefit. There is some suggestion from six papers that dose may be important, but no hard evidence. It remains unclear whether irradiation of metastatic sites is helpful. Technical advances may be of value in radiotherapy of high-risk neuroblastoma. CONCLUSIONS There are data that show that radiotherapy is of some efficacy in the management of high-risk neuroblastoma, but there is no level one evidence that shows that it is being used in the best possible way. Prospective randomised trials are necessary to provide more evidence to guide development of optimal radiotherapy treatment schedules.
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Affiliation(s)
- S Arumugam
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - N J Manning-Cork
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J E Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - T Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Gent, Belgium
| | - M N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
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11
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Yang S, Cai S, Ma X, Zeng Q, Qin H, Han W, Peng X, Wang H. Discrimination of histopathologic types of childhood peripheral neuroblastic tumors based on clinical and biological factors. Sci Rep 2018; 8:10924. [PMID: 30026516 PMCID: PMC6053409 DOI: 10.1038/s41598-018-29382-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/09/2018] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to discriminate the children malignant peripheral neuroblastic tumors (PNTs) from those with benign histotype ganglioneuroma (GN) based on clinical and biological characteristics in all PNTs. Four hundred and seventy-six patients were included in this study, containing 345 patients for model development and 131 patients for external validation. Multivariate logistic regression analysis was conducted to select potentially useful characteristics for discrimination of histopathology. External validation was performed for model evaluation. Compared with the main characteristics of GN (85/345, 24.6%), those of malignant PNTs (260/345, 75.4%) showed significant differences. Multivariate analysis was performed to further find the characteristics linked to histopathology. The results indicated that for the patients younger than 49 months, the primary site of adrenal and thoracic, the level of serum neuron-specific enolase (NSE) > 33 ng/mL, and tumor encasing blood vessels were the extremely important discrimination factors of malignant PNTs. The area under the receiver-operating-characteristic of the discrimination model was 0.96. The accuracy rate, sensitivity and specificity were 93.4%, 96.3% and 83.8%, respectively. Meanwhile, the accuracy rate of the external validation from the 131 patients was 97.0%. Overall, histopathologic type of childhood malignant PNTs can be discriminated based on age, primary site, NSE level and the relationship between primary tumor and blood vessels.
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Affiliation(s)
- Shen Yang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Siyu Cai
- Center for Clinical Epidemiology & Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiaoli Ma
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Qi Zeng
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hong Qin
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wei Han
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology & Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Huanmin Wang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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12
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Demoor-Goldschmidt C, Supiot S, Mahé MA, Oberlin O, Allodji R, Haddy N, Helfre S, Vigneron C, Brillaud-Meflah V, Bernier V, Laprie A, Ducassou A, Claude L, Diallo I, de Vathaire F. Clinical and histological features of second breast cancers following radiotherapy for childhood and young adult malignancy. Br J Radiol 2018; 91:20170824. [PMID: 29493262 DOI: 10.1259/bjr.20170824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine the characteristics of early second breast cancer (SBC) among survivors of childhood and young adult malignancy treated with irradiation. METHODS We conducted a multicenter retrospective study of women who presented with breast cancer aged 50 years or younger in nine French centers. RESULTS 121 patients and 141 SBC were analyzed (invasive = 130; non-invasive = 11). The mean age at first cancer diagnosis was 15 years and at initial SBC diagnosis was 38 years. Bilateral disease before the age of 51 years was diagnosed in 16% of the females. The majority of SBC were invasive carcinomas (92%). Among the invasive carcinomas, 39% had a histoprognostic score of III, 3.1% overexpressed HER2 and 29% were triple negative. The proportion of triple negative phenotype SBC was higher in patients older at first cancer diagnosis [RR = 1.2, 95% CI (1.1-1.3)]. 94% of triple negative SBCs developed in breast tissue which had received >20 Gy. CONCLUSION We found a high proportion of aggressive SBC following thoracic radiotherapy in childhood or early adulthood. Advances in knowledge: SBC screening is recommended by scientific societies for these child/young-adulthood cancer survivors in the same way as the one for high risk women because of constitutional mutations. Our results support these recommendations, not only because of a similar cumulative risk, but also because of the aggressive histological characteristics.
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Affiliation(s)
- Charlotte Demoor-Goldschmidt
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Stéphane Supiot
- 3 Department of Radiation Oncology, Institut de Cancérologie de l'Ouest , Saint-Herblain , France
| | - Marc-André Mahé
- 3 Department of Radiation Oncology, Institut de Cancérologie de l'Ouest , Saint-Herblain , France
| | - Odile Oberlin
- 4 Department of Pediatric Oncology, Institut Gustave Roussy , Villejuif , France
| | - Rodrigue Allodji
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Nadia Haddy
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Sylvie Helfre
- 5 Department of Radiotherapy, Institut Curie , Paris , France
| | - Céline Vigneron
- 6 Department of Radiotherapy, Centre Paul Strauss , Strasbourg , France
| | | | - Valérie Bernier
- 8 Department of Radiotherapy, Centre Alexis Vautrin , Nancy , France
| | | | | | | | - Ibrahim Diallo
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Florent de Vathaire
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
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13
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Swift CC, Eklund MJ, Kraveka JM, Alazraki AL. Updates in Diagnosis, Management, and Treatment of Neuroblastoma. Radiographics 2018. [DOI: 10.1148/rg.2018170132] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Caroline C. Swift
- From the Department of Radiology and Radiological Science (C.C.S., M.J.E.) and Department of Pediatrics (J.M.K.), Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Suite 210, Charleston, SC 29425; and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.L.A.)
| | - Meryle J. Eklund
- From the Department of Radiology and Radiological Science (C.C.S., M.J.E.) and Department of Pediatrics (J.M.K.), Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Suite 210, Charleston, SC 29425; and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.L.A.)
| | - Jacqueline M. Kraveka
- From the Department of Radiology and Radiological Science (C.C.S., M.J.E.) and Department of Pediatrics (J.M.K.), Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Suite 210, Charleston, SC 29425; and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.L.A.)
| | - Adina L. Alazraki
- From the Department of Radiology and Radiological Science (C.C.S., M.J.E.) and Department of Pediatrics (J.M.K.), Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Suite 210, Charleston, SC 29425; and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.L.A.)
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14
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Kushner BH, LaQuaglia MP, Modak S, Wolden SL, Basu EM, Roberts SS, Kramer K, Yataghene K, Cheung IY, Cheung NKV. MYCN-amplified stage 2/3 neuroblastoma: excellent survival in the era of anti-G D2 immunotherapy. Oncotarget 2017; 8:95293-95302. [PMID: 29221128 PMCID: PMC5707022 DOI: 10.18632/oncotarget.20513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/07/2017] [Indexed: 11/25/2022] Open
Abstract
High-risk neuroblastoma (HR-NB) includes MYCN-amplified stage 2/3, but reports covering anti-GD2 immunotherapy, which recently became standard for HR-NB, do not provide details on this subset. We now report on all 20 MYCN-amplified stage 2/3 patients who received induction chemotherapy at our center during the era of consolidation with anti-GD2 antibody 3F8/ granulocyte-macrophage colony-stimulating factor (GM-CSF) (2000-2015). Early in this period, consolidation included autologous stem-cell transplantation (ASCT). Event-free survival (EFS) and overall survival (OS) were estimated using Kaplan-Meier analyses. With induction, 19/20 (95%) patients achieved complete/very good partial remission (CR/VGPR) but one had progressive disease with early death. One responder did not receive consolidation and died of relapse. Five-year post-diagnosis EFS/OS rates for all 20 patients were 72%/84%. The 18 CR/VGPR patients who received consolidation had EFS/OS 81%/94% at five years from starting 3F8/GM-CSF: 4/4 ASCT patients remained relapse-free, while 11/14 non-ASCT patients remained relapse-free and two of the three relapsed patients achieved 2nd CR (consolidated by retreatment with 3F8/GM-CSF) and remained in 2nd CR at 36+ and 95+ months post-relapse. The 14 non-ASCT patients had EFS/OS 73.5%/93% at five years from starting 3F8/GM-CSF. This subset appears to have a good prognosis with contemporary multi-modality therapy, possibly even without ASCT.
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Affiliation(s)
- Brian H Kushner
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Michael P LaQuaglia
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Shakeel Modak
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ellen M Basu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Stephen S Roberts
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kim Kramer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Karima Yataghene
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Irene Y Cheung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Nai-Kong V Cheung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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15
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Demoor-Goldschmidt C, Drui D, Doutriaux I, Michel G, Auquier P, Dumas A, Berger C, Bernier V, Bohrer S, Bondiau PY, Filhon B, Fresneau B, Freycon C, Stefan D, Helfre S, Jackson A, Kerr C, Laprie A, Leseur J, Mahé MA, Oudot C, Pluchard C, Proust S, Sudour-Bonnange H, Vigneron C, Lassau N, Schlumberger M, Conter CF, de Vathaire F. A French national breast and thyroid cancer screening programme for survivors of childhood, adolescent and young adult (CAYA) cancers - DeNaCaPST programme. BMC Cancer 2017; 17:326. [PMID: 28499444 PMCID: PMC5427546 DOI: 10.1186/s12885-017-3318-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/03/2017] [Indexed: 02/04/2023] Open
Abstract
Background Survival of childhood, adolescent and young adult (CAYA) cancers has increased with progress in the management of the treatments and has reached more than 80% at 5 years. Nevertheless, these survivors are at great risk of second cancers and non-malignant co-morbidities in later life. DeNaCaPST is a non-interventional study whose aim is to organize a national screening for thyroid cancer and breast cancer in survivors of CAYA cancers. It will study the compliance with international recommendations, with the aim, regarding a breast screening programme, of offering for every woman living in France, at equal risk, an equal screening. Method DeNaCaPST trial is coordinated by the INSERM 1018 unit in cooperation with the LEA (French Childhood Cancer Survivor Study for Leukaemia) study’s coordinators, the long term follow up committee and the paediatric radiation committee of the SFCE (French Society of Childhood Cancers). A total of 35 centres spread across metropolitan France and la Reunion will participate. FCCSS (French Childhood Cancer Survivor Study), LEA and central registry will be interrogated to identify eligible patients. To participate, centers agreed to perform a complete “long-term follow-up consultations” according to good clinical practice and the guidelines of the SFCE (French Society of Children Cancers). Discussion As survival has greatly improved in childhood cancers, detection of therapy-related malignancies has become a priority even if new radiation techniques will lead to better protection for organs at risk. International guidelines have been put in place because of the evidence for increased lifetime risk of breast and thyroid cancer. DeNaCaPST is based on these international recommendations but it is important to recognize that they are based on expert consensus opinion and are supported by neither nonrandomized observational studies nor prospective randomized trials in this specific population. Over-diagnosis is a phenomenon inherent in any screening program and therefore such programs must be evaluated. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3318-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte Demoor-Goldschmidt
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.
| | - Delphine Drui
- Department of endocrinology, CHU de Nantes, 44000, Nantes, France
| | - Isabelle Doutriaux
- Department of radiology, Institut de Cancérologie de l'Ouest - René Gauducheau, 44800, Saint Herblain, France
| | - Gérard Michel
- Service d'hématologie et oncologie pédiatrique, Hôpital d'enfants La Timone, Marseille, France.,Unité de recherche EA 3279, Université Aix-Marseille, Marseille, France
| | - Pascal Auquier
- Unité de recherche EA 3279, Université Aix-Marseille, Marseille, France.,Service de santé publique, assistance publique - hôpitaux de Marseille et université Aix-Marseille, Marseille, France
| | - Agnès Dumas
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 94805, Villejuif, France
| | - Claire Berger
- Claire Berger, hemato-oncology pediatric department, chu nord st Etienne, cedex, 42055, St Etienne, France
| | - Valérie Bernier
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Sandrine Bohrer
- Oncology and Hematology Unit, CHU de Saint Denis de La Réunion, Saint Denis, France
| | | | - Bruno Filhon
- Department of Pediatric Hematology and Oncology, Rouen University Hospital, Rouen, France
| | - Brice Fresneau
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Pediatric oncology department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Claire Freycon
- Service d'hématologie et d'oncologie pédiatrique du CHU de Grenoble, Grenoble, France
| | - Dinu Stefan
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Sylvie Helfre
- Department of Radiation Oncology, institut Curie, Paris, France
| | - Angela Jackson
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France
| | - Christine Kerr
- Department of Radiation Oncology, institut du cancer de Montpellier, Montpellier, France
| | - Anne Laprie
- Department of Radiation Oncology, IUCT Oncopole, Toulouse, France
| | - Julie Leseur
- Department of Radiation Oncology, centre Eugène-Marquis, Rennes, France
| | | | - Caroline Oudot
- Pediatric Oncology Department, Hôpital de la Mère et de l'Enfant, 87042, Limoges, France
| | - Claire Pluchard
- Pediatric Oncology Department, chu Reims, hôpital américain, Reims, France
| | | | | | - Céline Vigneron
- Department of Radiation Oncology, Centre de lutte contre le Cancer Paul Strauss, Strasbourg, France
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy Cancer Campus Grand Paris, IR4M UMR8081, Université Paris Sud, Villejuif, France
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, 94805, Villejuif, France
| | | | - Florent de Vathaire
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 94805, Villejuif, France
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16
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Luksch R, Castellani MR, Collini P, De Bernardi B, Conte M, Gambini C, Gandola L, Garaventa A, Biasoni D, Podda M, Sementa AR, Gatta G, Tonini GP. Neuroblastoma (Peripheral neuroblastic tumours). Crit Rev Oncol Hematol 2016; 107:163-181. [PMID: 27823645 DOI: 10.1016/j.critrevonc.2016.10.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 09/05/2016] [Accepted: 10/03/2016] [Indexed: 02/07/2023] Open
Abstract
Peripheral neuroblastic tumours (PNTs), a family of tumours arising in the embryonal remnants of the sympathetic nervous system, account for 7-10% of all tumours in children. In two-thirds of cases, PNTs originate in the adrenal glands or the retroperitoneal ganglia. At least one third present metastases at onset, with bone and bone marrow being the most frequent metastatic sites. Disease extension, MYCN oncogene status and age are the most relevant prognostic factors, and their influence on outcome have been considered in the design of the recent treatment protocols. Consequently, the probability of cure has increased significantly in the last two decades. In children with localised operable disease, surgical resection alone is usually a sufficient treatment, with 3-year event-free survival (EFS) being greater than 85%. For locally advanced disease, primary chemotherapy followed by surgery and/or radiotherapy yields an EFS of around 75%. The greatest problem is posed by children with metastatic disease or amplified MYCN gene, who continue to do badly despite intensive treatments. Ongoing trials are exploring the efficacy of new drugs and novel immunological approaches in order to save a greater number of these patients.
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Affiliation(s)
- Roberto Luksch
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | | | - Paola Collini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Massimo Conte
- Giannina Gaslini Children's Research Hospital, Genoa, Italy
| | | | - Lorenza Gandola
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Davide Biasoni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Gemma Gatta
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gian Paolo Tonini
- Neuroblastoma Laboratory, Paediatric Research Institute, Padua, Italy
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18
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Elborai Y, Hafez H, Moussa EA, Hammad M, Hussein H, Lehmann L, Elhaddad A. Comparison of toxicity following different conditioning regimens (busulfan/melphalan and carboplatin/etoposide/melphalan) for advanced stage neuroblastoma: Experience of two transplant centers. Pediatr Transplant 2016; 20:284-9. [PMID: 26614402 DOI: 10.1111/petr.12638] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/28/2022]
Abstract
The outcome for advanced neuroblastoma has improved with combined modality therapy: induction chemotherapy, surgery, and consolidation with high-dose chemotherapy/autologous HSCT, followed by local radiation, cisretinoic acid, and recently antibody therapy. In the United States, the most common conditioning regimen is CEM, while in Europe/Middle East, Bu/Mel has been widely used; it remains unclear which regimen has the best outcome. Assess renal, hepatic, and infectious toxicity through Day+100 in 2 different regimens. Retrospective comparison between CEM-DFCHCC Boston and Bu/Mel- CCHE-57357. Thirty-five patients, median age 4, in Boston (2007-2011) and 38 patients, median age 3, in Cairo (2009-2011). Renal toxicity; creatinine was significantly higher in CEM than Bu/Mel: 57% (median day+90) vs. 29% (median>day+100), p = 0.004. One CEM patient died from renal dialysis at day+19. Hepatic toxicity was significantly higher in CEM than Bu/Mel: 80% (median day+26) vs. 58% (median day+60), p = 0.04. In infectious complications with CEM 14%, bacteremia (n = 4) and fungemia (n = 1), 3 had culture-negative sepsis requiring vasopressors. With Bu/Mel 18%, bacteremia (n = 7), none required pressors, p = 0.4. Bu/Mel was associated with less acute hepatic and renal toxicity and thus may be preferable for preserving organ functions.
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Affiliation(s)
- Yasser Elborai
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.,Pediatric Stem Cell Transplantation Unit, Dana Farber/Children's Hospital Cancer Care Center, Boston, MA, USA.,Pediatric Hematology/Oncology and Stem Cell Transplant Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.,Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Hanafy Hafez
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.,Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Emad A Moussa
- Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Mahmoud Hammad
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.,Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Hany Hussein
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.,Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Leslie Lehmann
- Pediatric Stem Cell Transplantation Unit, Dana Farber/Children's Hospital Cancer Care Center, Boston, MA, USA
| | - Alaa Elhaddad
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.,Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
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19
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Yalçin B, Kremer LCM, van Dalen EC. High-dose chemotherapy and autologous haematopoietic stem cell rescue for children with high-risk neuroblastoma. Cochrane Database Syst Rev 2015; 2015:CD006301. [PMID: 26436598 PMCID: PMC8783746 DOI: 10.1002/14651858.cd006301.pub4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite the development of new treatment options, the prognosis of high-risk neuroblastoma patients is still poor; more than half of patients experience disease recurrence. High-dose chemotherapy and haematopoietic stem cell rescue (i.e. myeloablative therapy) might improve survival. This review is the second update of a previously published Cochrane review. OBJECTIVES Primary objectiveTo compare the efficacy, that is event-free and overall survival, of high-dose chemotherapy and autologous bone marrow or stem cell rescue with conventional therapy in children with high-risk neuroblastoma. Secondary objectivesTo determine adverse effects (e.g. veno-occlusive disease of the liver) and late effects (e.g. endocrine disorders or secondary malignancies) related to the procedure and possible effects of these procedures on quality of life. SEARCH METHODS We searched the electronic databases The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, issue 11), MEDLINE/PubMed (1966 to December 2014) and EMBASE/Ovid (1980 to December 2014). In addition, we searched reference lists of relevant articles and the conference proceedings of the International Society for Paediatric Oncology (SIOP) (from 2002 to 2014), American Society for Pediatric Hematology and Oncology (ASPHO) (from 2002 to 2014), Advances in Neuroblastoma Research (ANR) (from 2002 to 2014) and American Society for Clinical Oncology (ASCO) (from 2008 to 2014). We searched for ongoing trials by scanning the ISRCTN register (www.isrct.com) and the National Institute of Health Register (www.clinicaltrials.gov). Both registers were screened in April 2015. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the efficacy of myeloablative therapy with conventional therapy in high-risk neuroblastoma patients. DATA COLLECTION AND ANALYSIS Two authors independently performed study selection, data extraction and risk of bias assessment. If appropriate, we pooled studies. The risk ratio (RR) and 95% confidence interval (CI) was calculated for dichotomous outcomes. For the assessment of survival data, we calculated the hazard ratio (HR) and 95% CI. We used Parmar's method if hazard ratios were not reported in the study. We used a random-effects model. MAIN RESULTS We identified three RCTs including 739 children. They all used an age of one year as the cut-off point for pre-treatment risk stratification. The first updated search identified a manuscript reporting additional follow-up data for one of these RCTs, while the second update identified an erratum of this study. There was a significant statistical difference in event-free survival in favour of myeloablative therapy over conventional chemotherapy or no further treatment (three studies, 739 patients; HR 0.78, 95% CI 0.67 to 0.90). There was a significant statistical difference in overall survival in favour of myeloablative therapy over conventional chemotherapy or no further treatment (two studies, 360 patients; HR 0.74, 95% CI 0.57 to 0.98). However, when additional follow-up data were included in the analyses the difference in event-free survival remained statistically significant (three studies, 739 patients; HR 0.79, 95% CI 0.70 to 0.90), but the difference in overall survival was no longer statistically significant (two studies, 360 patients; HR 0.86, 95% CI 0.73 to 1.01). The meta-analysis of secondary malignant disease and treatment-related death did not show any significant statistical differences between the treatment groups. Data from one study (379 patients) showed a significantly higher incidence of renal effects, interstitial pneumonitis and veno-occlusive disease in the myeloablative group compared to conventional chemotherapy, whereas for serious infections and sepsis no significant difference between the treatment groups was identified. No information on quality of life was reported. In the individual studies we evaluated different subgroups, but the results were not univocal in all studies. All studies had some methodological limitations. AUTHORS' CONCLUSIONS Based on the currently available evidence, myeloablative therapy seems to work in terms of event-free survival. For overall survival there is currently no evidence of effect when additional follow-up data are included. No definitive conclusions can be made regarding adverse effects and quality of life, although possible higher levels of adverse effects should be kept in mind. A definitive conclusion regarding the effect of myeloablative therapy in different subgroups is not possible. This systematic review only allows a conclusion on the concept of myeloablative therapy; no conclusions can be made regarding the best treatment strategy. Future trials on the use of myeloablative therapy for high-risk neuroblastoma should focus on identifying the most optimal induction and/or myeloablative regimen. The best study design to answer these questions is a RCT. These RCTs should be performed in homogeneous study populations (e.g. stage of disease and patient age) and have a long-term follow-up. Different risk groups, using the most recent definitions, should be taken into account.It should be kept in mind that recently the age cut-off for high risk disease was changed from one year to 18 months. As a result it is possible that patients with what is now classified as intermediate-risk disease have been included in the high-risk groups. Consequently the relevance of the results of these studies to the current practice can be questioned. Survival rates may be overestimated due to the inclusion of patients with intermediate-risk disease.
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Affiliation(s)
- Bilgehan Yalçin
- Hacettepe University Faculty of MedicinePediatric OncologyAnkaraTurkey06100
| | - Leontien CM Kremer
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyPO Box 22660AmsterdamNetherlands1100 DD
| | - Elvira C van Dalen
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyPO Box 22660AmsterdamNetherlands1100 DD
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Long-term side effects of radiotherapy for pediatric localized neuroblastoma : results from clinical trials NB90 and NB94. Strahlenther Onkol 2015; 191:604-12. [PMID: 25896312 DOI: 10.1007/s00066-015-0837-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/25/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Neuroblastoma (NB) is the most frequent indication for extracranial pediatric radiotherapy. As long-term survival of high-risk localized NB has greatly improved, we reviewed treatment-related late toxicities in pediatric patients who received postoperative radiotherapy (RT) for localized NB within two French prospective clinical trials: NB90 and NB94. PATIENTS AND METHODS From 1990-2000, 610 children were enrolled. Among these, 35 were treated with induction chemotherapy, surgery, and RT. The recommended RT dose was 24 Gy at ≤ 2 years, 34 Gy at > 2 years, ± a 5 Gy boost in both age groups. RESULTS The 22 patients still alive after 5 years were analyzed. The median follow-up time was 14 years (range 5-21 years). Late effects after therapy occurred in 73 % of patients (16/22), within the RT field for 50 % (11/22). The most frequent in-field effects were musculoskeletal abnormalities (n = 7) that occurred only with doses > 31 Gy/1.5 Gy fraction (p = 0.037). Other effects were endocrine in 3 patients and second malignancies in 2 patients. Four patients presented with multiple in-field late effects only with doses > 31 Gy. CONCLUSION After a median follow-up of 14 years, late effects with multimodality treatment were frequent. The most frequent effects were musculoskeletal abnormalities and the threshold for their occurrence was 31 Gy.
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La Quaglia MP. State of the art in oncology: high risk neuroblastoma, alveolar rhabdomyosarcoma, desmoplastic small round cell tumor, and POST-TEXT 3 and 4 hepatoblastoma. J Pediatr Surg 2014; 49:233-40. [PMID: 24528957 DOI: 10.1016/j.jpedsurg.2013.11.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/09/2013] [Indexed: 10/26/2022]
Abstract
Despite advances in the treatment of pediatric cancers during the past few decades, high-risk neuroblastoma, alveolar rhabdomyosarcoma, desmoplastic small round cell tumor, and hepatoblastomas with 3 or 4 sector involvement after chemotherapy continue to present significant challenges. This review summarizes recent research on the management of these diseases, with a special focus on the use of surgical debulking, genetic analysis, immunotherapy, and chemotherapy in improving outcomes of patients with these solid tumors.
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Yalçin B, Kremer LC, Caron HN, van Dalen EC. High-dose chemotherapy and autologous haematopoietic stem cell rescue for children with high-risk neuroblastoma. Cochrane Database Syst Rev 2013:CD006301. [PMID: 23970444 DOI: 10.1002/14651858.cd006301.pub3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Despite the development of new treatment options, the prognosis of high-risk neuroblastoma patients is still poor; more than half of patients experience disease recurrence. High-dose chemotherapy and haematopoietic stem cell rescue (i.e. myeloablative therapy) might improve survival. This review is an update of a previously published Cochrane review. OBJECTIVES The primary objective was to compare the efficacy of myeloablative therapy with conventional therapy in children with high-risk neuroblastoma. Secondary objectives were to determine possible effects of these interventions on adverse events, late effects and quality of life. SEARCH METHODS We searched the electronic databases CENTRAL (The Cochrane Library 2012, issue 6), MEDLINE/PubMed (1966 to June 2012) and EMBASE/Ovid (1980 to June 2012). In addition, we searched reference lists of relevant articles and the conference proceedings of the International Society for Paediatric Oncology (SIOP) (from 2002 to 2011), American Society for Pediatric Hematology and Oncology (ASPHO) (from 2002 to 2012), Advances in Neuroblastoma Research (ANR) (from 2002 to 2012) and American Society for Clinical Oncology (ASCO) (from 2008 to 2012). We searched for ongoing trials by scanning the ISRCTN register and the National Institute of Health Register (http://www.controlled-trials.com; both screened July 2012). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the efficacy of myeloablative therapy with conventional therapy in high-risk neuroblastoma patients. DATA COLLECTION AND ANALYSIS Two authors independently performed study selection, data extraction and risk of bias assessment. If appropriate, we pooled studies. The risk ratio (RR) and 95% confidence interval (CI) was calculated for dichotomous outcomes. For the assessment of survival data, we calculated the hazard ratio (HR) and 95% CI. We used Parmar's method if hazard ratios were not reported in the study. We used a random-effects model. MAIN RESULTS We identified three RCTs including 739 children. They all used an age of one year as the cut-off point for pre-treatment risk stratification. The updated search identified a manuscript reporting additional follow-up data for one of these RCTs. There was a statistically significant difference in event-free survival in favour of myeloablative therapy over conventional chemotherapy or no further treatment (3 studies, 739 patients; HR 0.78, 95% CI 0.67 to 0.90). There was a statistically significant difference in overall survival in favour of myeloablative therapy over conventional chemotherapy or no further treatment (2 studies, 360 patients; HR 0.74, 95% CI 0.57 to 0.98). However, when additional follow-up data were included in the analyses the difference in event-free survival remained statistically significant (3 studies. 739 patients; HR 0.79, 95% CI 0.70 to 0.90), but the difference in overall survival was no longer statistically significant (2 studies, 360 patients; HR 0.86, 95% CI 0.73 to 1.01). The meta-analysis of secondary malignant disease and treatment-related death did not show any statistically significant differences between the treatment groups. Data from one study (379 patients) showed a significantly higher incidence of renal effects, interstitial pneumonitis and veno-occlusive disease in the myeloablative group compared to conventional chemotherapy, whereas for serious infections and sepsis no significant difference between the treatment groups was identified. No information on quality of life was reported. In the individual studies we evaluated different subgroups, but the results were not univocal in all studies. All studies had some methodological limitations. AUTHORS' CONCLUSIONS Based on the currently available evidence, myeloablative therapy seems to work in terms of event-free survival. For overall survival there is currently no evidence of effect when additional follow-up data are included. No definitive conclusions can be made regarding adverse effects and quality of life, although possible higher levels of adverse effects should be kept in mind. A definitive conclusion regarding the effect of myeloablative therapy in different subgroups is not possible. This systematic review only allows a conclusion on the concept of myeloablative therapy; no conclusions can be made regarding the best treatment strategy. Future trials on the use of myeloablative therapy for high-risk neuroblastoma should focus on identifying the most optimal induction and/or myeloablative regimen. The best study design to answer these questions is a RCT. These RCTs should be performed in homogeneous study populations (e.g. stage of disease and patient age) and have a long-term follow-up. Different risk groups, using the most recent definitions, should be taken into account.It should be kept in mind that recently the age cut-off for high risk disease was changed from one year to 18 months. As a result it is possible that patients with what is now classified as intermediate-risk disease have been included in the high-risk groups. Consequently the relevance of the results of these studies to the current practice can be questioned. Survival rates may be overestimated due to the inclusion of patients with intermediate-risk disease.
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Affiliation(s)
- Bilgehan Yalçin
- Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey, 06100
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Yalçin B, Kremer LC, Caron HN, van Dalen EC. High-dose chemotherapy and autologous haematopoietic stem cell rescue for children with high-risk neuroblastoma. Cochrane Database Syst Rev 2010:CD006301. [PMID: 20464740 DOI: 10.1002/14651858.cd006301.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite the development of new treatment options, the prognosis of high-risk neuroblastoma patients is still poor; more than half of patients experience disease recurrence. High-dose chemotherapy and haematopoietic stem cell rescue (i.e. myeloablative therapy) might improve survival. OBJECTIVES To compare the effectiveness of myeloablative therapy with conventional therapy in children with high-risk neuroblastoma. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library 2009, issue 1), MEDLINE/PubMed (1966 to January 2009) and EMBASE/Ovid (1980 to January 2009). In addition, we searched reference lists of relevant articles, conference proceedings and ongoing trial databases. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effectiveness of myeloablative therapy with conventional therapy in high-risk neuroblastoma patients. DATA COLLECTION AND ANALYSIS Two authors independently performed study selection, data extraction and risk of bias assessment. If possible, we pooled results. MAIN RESULTS We identified three RCTs including 739 children. The meta-analysis of event-free survival showed a significant difference in favour of the myeloablative therapy group (HR 0.78; 95% CI 0.67 to 0.90), as did the meta-analysis of overall survival (HR 0.74; 95% CI 0.57 to 0.98). The meta-analysis of secondary malignant disease and treatment-related death did not show a significant difference between the treatment groups. In one study a significant difference in favour of the conventional therapy group was identified for renal effects, interstitial pneumonitis and veno-occlusive disease, whereas for serious infections and sepsis no significant difference between the treatment groups was identified. In the individual studies we evaluated different subgroups, but the results were not univocal in all studies. All studies had some methodological limitations. AUTHORS' CONCLUSIONS Based on the currently available evidence, myeloablative therapy seems to be a good treatment option for children with high-risk neuroblastoma. It results in higher survival rates than conventional therapy, although possible higher levels of adverse effects should be kept in mind. A definitive conclusion regarding the effect of myeloablative therapy in different subgroups is not possible. This systematic review only allows a conclusion on the concept of myeloablative therapy; no conclusions can be made regarding the best treatment strategy. Future trials on the use of myeloablative therapy for high-risk neuroblastoma should focus on identifying the most optimal induction and/or myeloablative regimen. The best study design to answer these questions is a RCT. These RCTs should be performed in homogeneous study populations (for example, regarding stage of disease and patient age) and have a long-term follow up. Different risk groups should be taken into account.
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Affiliation(s)
- Bilgehan Yalçin
- Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey, 06100
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Canete A, Gerrard M, Rubie H, Castel V, Di Cataldo A, Munzer C, Ladenstein R, Brichard B, Bermúdez JD, Couturier J, de Bernardi B, Pearson AJ, Michon J. Poor Survival for Infants WithMYCN-Amplified Metastatic Neuroblastoma Despite Intensified Treatment: The International Society of Paediatric Oncology European Neuroblastoma Experience. J Clin Oncol 2009; 27:1014-9. [DOI: 10.1200/jco.2007.14.5839] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo report the results of a prospective, nonrandomized European study on infants with neuroblastoma and MYCN gene amplification.Patients and MethodsInfants with neuroblastoma (stage 2, 3, 4, and 4s) and MYCN gene amplification who were diagnosed between 1999 and 2004 were eligible for enrollment onto the study. After diagnosis, staging, and mandatory biologic studies, induction chemotherapy (IC) with conventional drugs was administered, followed by delayed surgery, megatherapy (busulfan-melphalan as a conditioning regimen), and local radiotherapy.ResultsOf the 46 infants enrolled onto the study, 35 infants were eligible; of these 35 infants, 97% had metastatic spread (24 infants had stage 4, and 10 infants had stage 4s). Two-year overall survival (OS) was 30% (SE, 0.08), with median survival time of 12 months, and 23 deaths due to disease. Two-year, event-free survival (EFS) was 29% (SE, 0.07). The treatment was well tolerated with no deaths as a result of toxicity or severe toxicity. Despite protocol adherence, 30% of the patients who were assessable for response to IC experienced disease progression or did not respond. Stage and high lactate dehydrogenase reached significance in the univariate analysis (P = .028 and .039, respectively for OS; and P = .05 and .031 respectively, for EFS). Ten of 16 patients who received megatherapy are still alive.ConclusionAlthough treatment was well tolerated, survival was poor and our IC failed to achieve a satisfactory response in 30% of our patients. New therapeutic approaches and more intense world-wide collaboration are needed to achieve a cure in this population.
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Affiliation(s)
- Adela Canete
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - Mary Gerrard
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - Hervé Rubie
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - Victoria Castel
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - Andrea Di Cataldo
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - Caroline Munzer
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - Ruth Ladenstein
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - Bénédicte Brichard
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - José D. Bermúdez
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - Jerôme Couturier
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - Bruno de Bernardi
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - Andrew J. Pearson
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
| | - Jean Michon
- From La Fe Children's Hospital and Biostatistics Department, Universidad de Valencia, Valencia, Spain; Sheffield Children's Hospital, Sheffield; The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Hôpital des Enfants, Toulouse and Institute Curie, Paris, France; Centro di Riferimento Regionali di Ematologia ed Oncologia Pediatrica, Catania; G Gaslini Children's Hospital, Genoa, Italy; St Anna's Children's Hospital, Vienna, Austria; and Saint Luc University Hospital, Catholic University of Louvain
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Pagès PM, Dufour C, Fasola S, Michon J, Boutard P, Gentet JC, Hartmann O. Bilateral adrenal neuroblastoma. Pediatr Blood Cancer 2009; 52:196-202. [PMID: 18951434 DOI: 10.1002/pbc.21765] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bilateral adrenal neuroblastoma is extremely rare. To date, 45 cases have been reported in the literature. PROCEDURES We retrospectively identified and reviewed 15 cases of bilateral adrenal neuroblastoma, treated between 1988 and 2004, by the French Society of Pediatric Oncology. We then compared our cohort to the 45 cases reported in literature. RESULTS Median age at diagnosis was 4 months in our cohort whereas it was 3 months in the literature. The same percentage of infants was found in both series (86.6%). Disease had generally been detected due to metastasis-related symptoms. Ten out of 15 patients in our cohort and 18/39 cases in the literature were classified as stage 4S according to the International Neuroblastoma Staging System (INSS). The incidence of stage 4S was significantly higher than that described in other neuroblastoma cohorts (P = 10(-4)). Five-year overall survival was 90% for stage 4S. In our series, bilateral neuroblastoma was neither associated with familial cases nor with any risk factors. CONCLUSIONS The majority of bilateral neuroblastoma carry a favorable prognosis. Exceptional cases exhibiting risk factors, such as amplified MYCN, are comparable to high-risk unilateral neuroblastoma cases with the same poor prognostic features. The therapeutic strategy could be similar to that used against unilateral neuroblastoma, except for surgery. However, the low incidence of relapse and the risk of adrenal failure if radical surgery is performed, argue against an aggressive surgical approach.
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Modak S, Kushner BH, LaQuaglia MP, Kramer K, Cheung NKV. Management and outcome of stage 3 neuroblastoma. Eur J Cancer 2009; 45:90-8. [PMID: 18996003 PMCID: PMC3727624 DOI: 10.1016/j.ejca.2008.09.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 08/24/2008] [Accepted: 09/25/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE The management of patients with International Neuroblastoma Staging System (INSS) stage 3 neuroblastoma (NB) is not consistent worldwide. We describe a single centre approach at Memorial Sloan-Kettering Cancer Centre (MSKCC) from 1991 to 2007 that minimises therapy except for those patients with MYCN-amplified NB. METHODS In this retrospective analysis of 69 patients, tumour MYCN was not amplified in 53 and amplified in 16. Event-free survival (EFS) and overall survival (OS) were determined by Kaplan-Meier analysis. RESULTS Fourteen patients with non-MYCN-amplified tumours were treated with surgery alone (group A) and the remaining 39 (group B) with surgery following chemotherapy that was initiated and administered at non-MSKCC institutions. Chemotherapy was discontinued after surgery in 38/39 of the latter. The 10-year EFS and OS for all patients with MYCN-non-amplified NB were 74.9+/-16.9% and 92.6+/-5.5%, respectively. There was no difference in OS between groups A and B (p=0.2; 10-year OS for groups A and B was 84.6+/-14% and 97.1+/-2.9%, respectively). Patients with MYCN-amplified disease (group C) underwent dose-intensive induction, tumour resection and local radiotherapy: 13 achieved complete or very good partial remission, and 10 received myeloablative chemotherapy. 11/16 patients also received 3F8-based immunotherapy: 10 remain free of disease. The 10-year EFS and OS for patients with MYCN-amplified neuroblastoma treated with immunotherapy were both 90.9+/-8.7%. CONCLUSION Patients with MYCN-non-amplified stage 3 NB can be successfully treated with surgery without the need for radiotherapy or continuation of chemotherapy. Combination of dose-intensive chemotherapy, surgery, radiotherapy and immunotherapy was associated with a favourable outcome for most patients with MYCN-amplified stage 3 NB.
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Affiliation(s)
- Shakeel Modak
- Department of Paediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Brian H. Kushner
- Department of Paediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
- Tel.: +1 212 639 6793
| | - Michael P. LaQuaglia
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
- Tel.: +1 212 639 7002
| | - Kim Kramer
- Department of Paediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
- Tel.: +1 212 639 6410
| | - Nai-Kong V. Cheung
- Department of Paediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
- Tel.: +1 646 888 2313
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Angiogenesis as a target in neuroblastoma. Eur J Cancer 2008; 44:1645-56. [DOI: 10.1016/j.ejca.2008.05.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Revised: 05/16/2008] [Accepted: 05/21/2008] [Indexed: 11/17/2022]
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Yalçin B, van Dalen EC, Caron HN, Kremer LCM. High dose chemotherapy and autologous stem cell rescue for children with high risk neuroblastoma. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2006. [DOI: 10.1002/14651858.cd006301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cecchetto G, Mosseri V, De Bernardi B, Helardot P, Monclair T, Costa E, Horcher E, Neuenschwander S, Tomà P, Rizzo A, Michon J, Holmes K. Surgical Risk Factors in Primary Surgery for Localized Neuroblastoma: The LNESG1 Study of the European International Society of Pediatric Oncology Neuroblastoma Group. J Clin Oncol 2005; 23:8483-9. [PMID: 16293878 DOI: 10.1200/jco.2005.02.4661] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Although tumor resection is the mainstay of treatment for localized neuroblastoma, there are no established guidelines indicating which patients should be operated on immediately and which should undergo surgery after tumor reduction with chemotherapy. In an effort to develop such guidelines, the LNESG1 study defined surgical risk factors (SRFs) based on the imaging characteristics. Patients and Methods A total of 905 patients with suspected localized neuroblastoma were registered by 10 European countries between January 1995 and October 1999; 811 of 905 patients were eligible for this analysis. Results Information on SRFs was obtained for 719 of 811 patients; 367 without and 352 with SRFs. Of these 719 patients, 201 patients (four without and 197 with SRFs) underwent biopsy only. An attempt at tumor excision was made in 518 patients: 363 of 367 patients without and 155 of 352 patients with SRFs (98.9% v 44.0%). Complete excision was achieved in 271 of 363 patients without and in 72 of 155 patients with SRF (74.6% v 46.4%), near-complete excision was achieved in 81 and 61 patients (22.3% v 39.3%), and incomplete excision was achieved in 11 and 22 patients (3.0% v 14.2%), respectively. There were two surgery-related deaths. Nonfatal surgery-related complications occurred in 45 of 518 patients (8.7%) and were less frequent in patients without SRFs (5.0% v 17.4%). Associated surgical procedures were also less frequent in patients without SRFs (1.6% v 9.7%). Conclusion The adoption of SRFs as predictors of adverse surgical outcome was validated because their presence was associated with lower complete resection rate and greater risk of surgery-related complications. Additional studies aiming to better define the surgical approach to localized neuroblastoma are warranted.
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Affiliation(s)
- Giovanni Cecchetto
- Division of Pediatric Surgery, Department of Pediatrics, University of Padova, Italy
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