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Gow KW, Lautz TB, Malek MM, Cost NG, Newman EA, Dasgupta R, Christison-Lagay ER, Tiao GM, Davidoff AM. Children's Oncology Group's 2023 blueprint for research: Surgery. Pediatr Blood Cancer 2024; 71:e30766. [PMID: 37950538 PMCID: PMC10872730 DOI: 10.1002/pbc.30766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
Surgery plays a crucial role in the treatment of children with solid malignancies. A well-conducted operation is often essential for cure. Collaboration with the primary care team is important for determining if and when surgery should be performed, and if performed, an operation must be done in accordance with well-established standards. The long-term consequences of surgery also need to be considered. Indications and objectives for a procedure vary. Providing education and developing and analyzing new research protocols that include aims relevant to surgery are key objectives of the Surgery Discipline of the Children's Oncology Group. The critical evaluation of emerging technologies to ensure safe, effective procedures is another key objective. Through research, education, and advancing technologies, the role of the pediatric surgeon in the multidisciplinary care of children with solid malignancies will continue to evolve.
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Affiliation(s)
- Kenneth W. Gow
- Division of General & Thoracic Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Timothy B. Lautz
- Department of Pediatric Surgery, Lurie Children’s Hospital of Chicago, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Marcus M. Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas G. Cost
- Department of Surgery, Division of Urology and the Surgical Oncology Program, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Erika A. Newman
- Department of Surgery, Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Emily R. Christison-Lagay
- Division of Pediatric Surgery, Yale School of Medicine, Yale-New Haven Children’s Hospital, New Haven, Connecticut, USA
| | - Gregory M. Tiao
- Division of Pediatric General and Thoracic Surgery, Cincinnati Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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Morin CE, Hasweh R, Anton C, Dillman JR, Orscheln E, Smith EA, Kotagal M, Weiss BD, Ouyang J, Zhang B, Trout AT, Towbin AJ. Gadolinium-based contrast media does not improve the staging of neuroblastoma image-defined risk factors at diagnosis. Pediatr Blood Cancer 2024; 71:e30724. [PMID: 37845799 DOI: 10.1002/pbc.30724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/23/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Neuroblastoma risk stratification relies on prognostic risk factors and image-defined risk factors (IDRFs). Evaluating neuroblastoma typically involves magnetic resonance imaging (MRI) with gadolinium-based contrast media (GBCM, "contrast"). However, there are concerns regarding adverse effects and cost of GBCM. We aimed to assess the impact of intravenous GBCM on interobserver agreement for neuroblastoma staging on baseline MRI. PROCEDURE We reviewed baseline MRI scans of 50 children with abdominopelvic neuroblastomas confirmed by histopathology. Duplicate sets of images were created, with post-contrast T1-weighted sequences removed from one set. Four pediatric radiologists independently analyzed the scans in a randomized manner. They recorded primary tumor size, presence of IDRFs, and metastatic lesions. Agreement among the reviewers was measured using kappa and Fleiss kappa statistics. RESULTS Mean age of included children was 3.3 years (range: 0.01-14.9 years), and 20 [40%] were females. Mean tumor size was 5.7 cm in greatest axial diameter. Pre-contrast versus post-contrast MRI showed excellent agreement for tumor measurement. Overlapping confidence intervals (CIs) were seen in nearly all categories of interobserver agreement on the presence or absence of individual IDRFs, with agreement ranging from poor to substantial, regardless of the presence of contrast. The overall interobserver agreement on the presence of at least one IDRF was substantial with contrast (kappa = .63; 95% CI: .52-.75) and moderate without contrast (kappa = .5; 95% CI: .39-.61); although the overlapping CIs suggest a lack of meaningful difference. Similarly, interobserver agreement on the presence or absence of individual sites of metastatic disease ranged from poor to substantial. The interobserver agreement on the overall determination of presence of metastatic disease was fair with contrast (kappa = .49; 95% CI: .38-.61) and moderate without contrast (kappa = .71; 95% CI: .59-.826). CONCLUSIONS Contrast does not improve tumor size measurement or radiologist agreement on the presence or absence of IDRFs or metastatic disease in children with newly diagnosed neuroblastoma.
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Affiliation(s)
- Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Reem Hasweh
- Division of Radiology, Al-Balqa Applied University, Al-Salt, Jordan
| | - Chris Anton
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Emily Orscheln
- Department of Radiology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Ethan A Smith
- Department of Surgery, University of Cincinnati College of Medicine, Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meera Kotagal
- Cancer and Blood Disease Institute, Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brian D Weiss
- Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jiarong Ouyang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Krivonosov AA, Minnullin MM, Akhaladze DG, Grachev NS. [Surgery for abdominal neuroblastoma in children]. Khirurgiia (Mosk) 2024:152-160. [PMID: 38785252 DOI: 10.17116/hirurgia2024051152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
This review is devoted to surgical approach for neurogenic tumors in children. The authors discuss epidemiological data, history of surgical approaches, preoperative imaging and risk factors. A special attention is paid to the influence of surgical interventions for various neuroblastomas on overall and event-free survival in pediatric population, as well as the most common surgical complications and modern approaches to their treatment.
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Affiliation(s)
- A A Krivonosov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - M M Minnullin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - D G Akhaladze
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - N S Grachev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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Scherer S, Mayer BFB, Dietzel M, Esser M, Warmann SW, Lang P, Schuhmann MU, Schmidt A, Fuchs J. The role of surgery in the treatment of neuroblastoma metastases at rare sites. J Cancer Res Clin Oncol 2023; 149:12913-12921. [PMID: 37466795 PMCID: PMC10587098 DOI: 10.1007/s00432-023-05147-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/08/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Treatment of neuroblastoma metastases usually consists of chemotherapy and irradiation. However, in selected cases, surgical treatment is also indicated. In this study, we present three cases of patients with neuroblastoma metastases at rare sites that underwent surgery. MATERIALS AND METHODS We retrospectively analyzed data of patients who underwent surgery for neuroblastoma at our department of Pediatric Surgery and Pediatric Urology at the University Children's Hospital in Tuebingen and selected those patients who had surgery explicitly for a metastasis. RESULTS Between 2002 and 2020, 277 children underwent surgical treatment for neuroblastoma. Three cases with metastases at exceptional sites are presented here after therapy according to protocols. One patient had a penile metastasis and received surgery including a plastic reconstruction. The patient showed no signs of erectile or urinary dysfunction at follow-up. Another patient had a metastasis in the proximal ulna, which remained vital even after exhausted treatment after two relapses. Afterward there was no restriction of movement of the extremity. The third patient had, amongst others, metastases to the pancreatic body and to the liver. Both were surgically removed during primary tumor resection. This patient died after local tumor relapse. The other two patients showed no evidence of tumor relapse after a follow-up of 18 and 17 months, respectively. CONCLUSION Although children with neuroblastoma often present with metastases, there is no recommendation for surgical treatment other than diagnostic biopsies. In case of persistence of metastasis or after exhaustion of high-risk therapy, surgical resection must be considered.
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Affiliation(s)
- Simon Scherer
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Benjamin F B Mayer
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Markus Dietzel
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Michael Esser
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Steven W Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Peter Lang
- Department of General Pediatrics, Hematology and Oncology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Martin U Schuhmann
- Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Shaffiey SA, Le HD, Christison-Lagay E, Fialkowski EA, Aldrink JH, Grant CN, Honeyman JN, Janek KC, Madonna MB, Rhee DS, Nuchtern JG, Newman EA, LaQuaglia MP, Davidoff AM, Shamberger RC, Malek MM. Critical elements of pediatric neuroblastoma surgery. Semin Pediatr Surg 2023; 32:151338. [PMID: 38042090 DOI: 10.1016/j.sempedsurg.2023.151338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
Neuroblastoma (NB) is the most common solid extracranial malignancy of childhood with an incidence of 1 per 100,000 in the United States compromising approximately 10 % of childhood cancer. Unfortunately, patients with high-risk NG continue to have long-term survival less than 50 %. Both Children's Oncology Group and the International Society of Paediatric Oncology have demonstrated the important role of surgery in the treatment of high-risk NB. Herein, we compose the results of an extensive literature review as well as expert opinion from leaders in pediatric surgical oncology, to present the critical elements of effective surgery for high-risk neuroblastoma.
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Affiliation(s)
| | - Hau D Le
- University of Wisconsin-Madison, Madison WI 53705, USA
| | | | | | - Jennifer H Aldrink
- Nationwide Children's Hospital OSU College of Medicine, Columbus, OH 43205, USA
| | - Christa N Grant
- Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY 10595, USA
| | | | - Kevin C Janek
- Children's Hospital of Michigan, Detroit, MI 48201, USA
| | | | | | - Jed G Nuchtern
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA
| | | | | | | | | | - Marcus M Malek
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
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Chaika M, Männlin S, Gassenmaier S, Tsiflikas I, Dittmann H, Flaadt T, Warmann S, Gückel B, Schäfer JF. Combined Metabolic and Functional Tumor Volumes on [ 18F]FDG-PET/MRI in Neuroblastoma Using Voxel-Wise Analysis. J Clin Med 2023; 12:5976. [PMID: 37762918 PMCID: PMC10531552 DOI: 10.3390/jcm12185976] [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: 08/19/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE The purpose of our study was to evaluate the association between the [18F]FDG standard uptake value (SUV) and the apparent diffusion coefficient (ADC) in neuroblastoma (NB) by voxel-wise analysis. METHODS From our prospective observational PET/MRI study, a subcohort of patients diagnosed with NB with both baseline imaging and post-chemotherapy imaging was further investigated. After registration and tumor segmentation, metabolic and functional tumor volumes were calculated from the ADC and SUV values using dedicated software allowing for voxel-wise analysis. Under the mean of thresholds, each voxel was assigned to one of three virtual tissue groups: highly vital (v) (low ADC and high SUV), possibly low vital (lv) (high ADC and low SUV), and equivocal (e) with high ADC and high SUV or low ADC and low SUV. Moreover, three clusters were generated from the total tumor volumes using the method of multiple Gaussian distributions. The Pearson's correlation coefficient between the ADC and the SUV was calculated for each group. RESULTS Out of 43 PET/MRIs in 21 patients with NB, 16 MRIs in 8 patients met the inclusion criteria (PET/MRIs before and after chemotherapy). The proportion of tumor volumes were 26%, 36%, and 38% (v, lv, e) at baseline, 0.03%, 66%, and 34% after treatment in patients with response, and 42%, 25%, and 33% with progressive disease, respectively. In all clusters, the ADC and the SUV correlated negatively. In the cluster that corresponded to highly vital tissue, the ADC and the SUV showed a moderate negative correlation before treatment (R = -0.18; p < 0.0001) and the strongest negative correlation after treatment (R = -0.45; p < 0.0001). Interestingly, only patients with progression (n = 2) under therapy had a relevant part in this cluster post-treatment. CONCLUSION Our results indicate that voxel-wise analysis of the ADC and the SUV is feasible and can quantify the different quality of tissue in neuroblastic tumors. Monitoring ADCs as well as SUV levels can quantify tumor dynamics during therapy.
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Affiliation(s)
- Maryanna Chaika
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Simon Männlin
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Sebastian Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Ilias Tsiflikas
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Helmut Dittmann
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Tim Flaadt
- Department of Hematology and Oncology, University Children’s Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Steven Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children’s Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Brigitte Gückel
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Jürgen Frank Schäfer
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
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Gupta M, Kannappan S, Jain M, Douglass D, Shah R, Bose P, Narendran A. Development and validation of a 21-gene prognostic signature in neuroblastoma. Sci Rep 2023; 13:12526. [PMID: 37532697 PMCID: PMC10397261 DOI: 10.1038/s41598-023-37714-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Survival outcomes for patients with neuroblastoma vary markedly and reliable prognostic markers and risk stratification tools are lacking. We sought to identify and validate a transcriptomic signature capable of predicting risk of mortality in patients with neuroblastoma. The TARGET NBL dataset (n = 243) was used to develop the model and two independent cohorts, E-MTAB-179 (n = 478) and GSE85047 (n = 240) were used as validation sets. EFS was the primary outcome and OS was the secondary outcome of interest for all analysis. We identified a 21-gene signature capable of stratifying neuroblastoma patients into high and low risk groups in the E-MTAB-179 (HR 5.87 [3.83-9.01], p < 0.0001, 5 year AUC 0.827) and GSE85047 (HR 3.74 [2.36-5.92], p < 0.0001, 5 year AUC 0.815) validation cohorts. Moreover, the signature remained independent of known clinicopathological variables, and remained prognostic within clinically important subgroups. Further, the signature was effectively incorporated into a risk model with clinicopathological variables to improve prognostic performance across validation cohorts (Pooled Validation HR 6.93 [4.89-9.83], p < 0.0001, 5 year AUC 0.839). Similar prognostic utility was also demonstrated with OS. The identified signature is a robust independent predictor of EFS and OS outcomes in neuroblastoma patients and can be combined with clinically utilized clinicopathological variables to improve prognostic performance.
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Affiliation(s)
- Mehul Gupta
- Department of Pediatrics and Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Sunand Kannappan
- Department of Pediatrics and Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Mohit Jain
- Department of Pediatrics and Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - David Douglass
- Department of Pediatrics, Hematology/Oncology Section, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, 72202, USA
| | - Ravi Shah
- Department of Pediatrics and Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Pinaki Bose
- Departments of Oncology and Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
- Cumming School of Medicine, Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada.
| | - Aru Narendran
- Department of Pediatrics and Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
- Departments of Oncology and Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
- Cumming School of Medicine, Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada.
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Jia X, Liang J, Ma X, Wang W, Lai C. Radiomic-based machine learning model for predicting the surgical risk in children with abdominal neuroblastoma. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000531. [PMID: 37223779 PMCID: PMC10201264 DOI: 10.1136/wjps-2022-000531] [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: 11/18/2022] [Accepted: 03/27/2023] [Indexed: 05/25/2023] Open
Abstract
Background Preoperative imaging assessment of surgical risk is very important for the prognosis of these children. To develop and validate a radiomics-based machine learning model based on the analysis of radiomics features to predict surgical risk in children with abdominal neuroblastoma (NB). Methods A retrospective study was conducted from April 2019 to March 2021 among 74 children with abdominal NB. A total of 1874 radiomic features in MR images were extracted from each patient. Support vector machines (SVMs) were used to establish the model. Eighty percent of the data were used as the training set to optimize the model, and 20% of the data were used to validate its accuracy, sensitivity, specificity and area under the curve (AUC) to verify its effectiveness. Results Among the 74 children with abdominal NB, 55 (65%) had surgical risk and 19 (35%) had no surgical risk. A t test and Lasso identified that 28 radiomic features were associated with surgical risk. After developing an SVM-based model using these features, predictions were made about whether children with abdominal NB had surgical risk. The model achieved an AUC of 0.94 (a sensitivity of 0.83 and a specificity of 0.80) with 0.890 accuracy in the training set and an AUC of 0.81 (a sensitivity of 0.73 and a specificity of 0.82) with 0.838 accuracy in the test set. Conclusions Radiomics and machine learning can be used to predict the surgical risk in children with abdominal NB. The model based on 28 radiomic features established by SVM showed good diagnostic efficiency.
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Affiliation(s)
- Xuan Jia
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiawei Liang
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaohui Ma
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenqi Wang
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Can Lai
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Association of image-defined risk factors with clinical features, tumor biology, and outcomes in neuroblastoma: a single-center retrospective study. Eur J Pediatr 2023; 182:2189-2196. [PMID: 36856889 DOI: 10.1007/s00431-023-04899-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023]
Abstract
Image-defined risk factors (IDRF) in neuroblastoma have been developed to predict tumor resectability and surgical complications; however, the potential prognostic value of IDRF in neuroblastoma has been variably reported. Previous studies did not report the IDRF status separately from the International Neuroblastoma Risk Group (INRG) stage. Moreover, the association between IDRF and clinical and pathological factors has not been discussed further. In this retrospective study, we investigated the clinical and biological features of neuroblastoma at different INRG stages based on IDRF. Event-free survival (EFS) and overall survival (OS) related to the INRG stage were analyzed using log-rank tests, and the prognostic value of the IDRF number and type was also evaluated. Among 72 patients, 182 IDRF at diagnosis were found in 79.2%. The distribution of the INRG stages was 10 L1 (13.9.0%), 25 L2 (34.7%), and 37 M/MS (51.4%). Patients with stage M/Ms had a larger tumor volume, a higher percentage of age ≥ 18 months, elevated lactate dehydrogenase (LDH) level, elevated ferritin level, and a higher percentage of COG high-risk compared with stage L1 and L2 patients. EFS and OS were similar for stage L1 and L2 tumors but were significantly poorer for metastatic disease. However, EFS (P = 0.06) and OS (P = 0.07) were similar for IDRF-negative and positive neuroblastomas. Patients with stage M/Ms with IDRF-positive had poorer EFS (P = 0.001) and OS (P < 0.001) compared with patients in stage L2. An IDRF ≥ 4, vascular IDRF, and infiltrative IDRF of the tumor were significant indicators of poor prognosis. Conclusion: Our study indicates that increasing the INRG stages based on IDRF is associated with various unfavorable clinical features of neuroblastoma. The principal determinant of survival in neuroblastoma is the presence of metastatic disease more than IDRF alone at diagnosis. Both the number and type of IDRF have important clinical significance in the protocol planning of neuroblastoma, rather than just considering the absence or presence of IDRF. What is Known: • The International Neuroblastoma Risk Group Staging System (INRGSS) now employs image-defined risk factors (IDRFs) to stratify and stage disease. • The presence of IDRF at diagnosis are associated with higher rates of operative complications and incomplete surgical resection. What is New: • The principal determinant of survival from neuroblastoma is the presence of metastatic disease at diagnosis, more than IDRF alone. • IDRF number and type should also be considered during the diagnosis and treatment planning of neuroblastoma, rather than just considering the absence or presence of IDRF.
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Wieczorek A, Szewczyk K, Klekawka T, Stefanowicz J, Ussowicz M, Drabik G, Pawinska-Wasikowska K, Balwierz W. Segmental chromosomal aberrations as the poor prognostic factor in children over 18 months with stage 3 neuroblastoma without MYCN amplification. Front Oncol 2023; 13:1134772. [PMID: 36865795 PMCID: PMC9972431 DOI: 10.3389/fonc.2023.1134772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Patients with stage 3 neuroblastoma (NBL) according to International Neuroblastoma Staging System (INSS) without MYCN amplification represent a heterogenous group with respect to disease presentation and prognosis. Methods Retrospective analysis of 40 stage 3 patients with NBL without MYCN amplification was performed. The prognostic value of age at diagnosis (under 18 vs over 18 months), International Neuroblastoma Pathology Classification (INPC) diagnostic category and presence of segmental or numerical chromosomes aberrations were evaluated, as well as biochemical markers. Array comparative genomic hybridization (aCGH) for analyzing copy number variations and Sanger sequencing for ALK point mutations were done. Results In 12 patients (two patients under 18 months), segmental chromosomal aberrations (SCA) were found and numerical chromosomal aberrations (NCA) were found in 16 patients (14 patients under 18 months). In children over 18 months SCA were more common (p=0.0001). Unfavorable pathology was significantly correlated with SCA genomic profile (p=0.04) and age over 18 months (p=0.008). No therapy failures occurred in children with NCA profile over or under 18 months or in children under 18 months, irrespective of pathology and CGH results. Three treatment failures occurred in the SCA group, in one patient CGH profile was not available. For the whole group at 3, 5 and 10-year OS and DFS were 0.95 (95% CI 0.81-0.99), 0.91 (95% CI 0.77-0.97) and 0.91 (95% CI 0.77-0.97), and 0.95 (95% CI 0.90-0.99), 0.92 (95% CI 0.85-0.98) and 0.86 (95% CI 0.78-0.97), respectively. DFS was significantly lower in the SCA group than in the NCA group (3-years, 5-years, and 10-years DFS 0.92 (95% CI 0.53-0.95), 0.80 (95% CI 0.40-0.95) and 0.60 (95% CI 0.16-0.87) vs 1.0, 1.0 and 1.0, respectively, p=0.005). Conclusions The risk of treatment failure was higher in patients with SCA profile, but only in patients over 18 months. All relapses occurred in children having obtained the complete remission, with no previous radiotherapy. In patients over 18 months, SCA profile should be taken into consideration for therapy stratification as it increases the risk of relapse and this group may require more intensive treatment.
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Affiliation(s)
- Aleksandra Wieczorek
- Department of Pediatric Oncology and Hematology, Medical College, Jagiellonian University, Krakow, Poland,Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, Krakow, Poland,*Correspondence: Aleksandra Wieczorek, ; Katarzyna Pawinska-Wasikowska,
| | - Katarzyna Szewczyk
- Department of Medical Genetics, Institute of Pediatrics, Medical College, Jagiellonian University, Krakow, Poland
| | - Tomasz Klekawka
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, Krakow, Poland
| | - Joanna Stefanowicz
- Department of Pediatrics, Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Grazyna Drabik
- Department of Pathology, University Children’s Hospital of Krakow, Krakow, Poland
| | - Katarzyna Pawinska-Wasikowska
- Department of Pediatric Oncology and Hematology, Medical College, Jagiellonian University, Krakow, Poland,Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, Krakow, Poland,*Correspondence: Aleksandra Wieczorek, ; Katarzyna Pawinska-Wasikowska,
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Medical College, Jagiellonian University, Krakow, Poland,Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, Krakow, Poland
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11
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Abstract
PURPOSE To analyze the role of laparoscopic surgery for the management of pediatric adrenal tumors (AT). METHODS Retrospective analysis of children diagnosed with AT, operated laparoscopically during 2003-2020. The strategy differed according to tumor extension. AT < 6 cm were resected. Locally advanced tumors (L2) or > 6 cm were biopsied. RESULTS N = 28. Complete tumor resection (R0) in 20 (71%), tumor biopsy in 8 (R2). Age (median): 28.8 months (2 months-18 years). 14/28 left-sided, 2 bilateral. Median operating time: 78 min (45-180). Mean tumor size (for resections): 4 cm (2.5-6). Tumor pathology: neuroblastoma (n = 17), Ganglioneuroma (n = 7), Adrenocortical carcinoma (n = 1), Osteosarcoma metastasis (n = 1), Pheochromocytoma (n = 1), Venous malformation (n = 1). Mean hospital stay: 2.5 days (1-3). Mean follow up: 65.5 months (24-192). Overall survival and event-free survival were 86 and 75%, respectively (5 years event-free survival for neuroblastoma: 33% [intermediate risk], 16.6% [high risk]. No surgery-related mortality. CONCLUSION Laparoscopic surgery for adrenal tumors is safe. Laparoscopic biopsy is useful for unresectable tumors when a percutaneous approach is not possible. With the proposed selection criteria, the laparoscopic approach should be the first option for resection of small and localized AT in pediatrics.
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12
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LaQuaglia MP, Gerstle JT. Advances in the treatment of pediatric solid tumors: A 50-year perspective. J Surg Oncol 2022; 126:933-942. [PMID: 36087080 PMCID: PMC9473291 DOI: 10.1002/jso.27038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 12/17/2022]
Abstract
In the United States, more than 10 000 cancers occur annually in children aged 0-14 years, and more than 5000 in adolescents aged 15-19. In the last 50 years, significant advances have been made in imaging, molecular pathology, stage and risk assessment, surgical approach, multidisciplinary treatment, and survival for pediatric solid tumors (particularly neuroblastoma, Wilms tumor, rhabdomyosarcoma, and hepatoblastoma). Moreover, the molecular driver for fibrolamellar hepatocellular carcinoma, which occurs in adolescence and young adulthood, has been identified.
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Affiliation(s)
- Michael P LaQuaglia
- Pediatric Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Justin T Gerstle
- Pediatric Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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13
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Minimally invasive surgery for neuroblastic tumours: A SIOPEN multicentre study: Proposal for guidelines. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 48:283-291. [PMID: 34489122 DOI: 10.1016/j.ejso.2021.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Surgery plays a key role in the management of Neuroblastic tumours (NB), where the standard approach is open surgery, while minimally invasive surgery (MIS) may be considered an option in selected cases. The indication(s) and morbidity of MIS remain undetermined due to small number of reported studies. The aim of this study was to critically address the contemporary indications, morbidity and overall survival (OS) and propose guidelines exploring the utility of MIS for NB. MATERIALS & METHODS A SIOPEN study where data of patients with NB who underwent MIS between 2005 and 2018, including demographics, tumour features, imaging, complications, follow up and survival, were extracted and then analysed. RESULTS A total of 222 patients from 16 centres were identified. The majority were adrenal gland origin (54%) compared to abdominal non-adrenal and pelvic (16%) and thoracic (30%). Complete and near complete macroscopic resection (>95%) was achieved in 95%, with 10% of cases having conversion to open surgery. Complications were reported in 10% within 30 days of surgery. The presence of IDRF (30%) and/or tumour volume >75 ml were risk factors for conversion and complications in multivariate analysis. Overall mortality was 8.5%. CONCLUSIONS MIS for NB showed that it is a secure approach allowing more than 95% resection. The presence of IDRFs was not an absolute contraindication for MIS. Conversion to open surgery and overall complication rates were low, however they become significant if tumour volume >75 mL. Based on these data, we propose new MIS guidelines for neuroblastic tumours.
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14
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Froeba-Pohl A, von Schweinitz D, Muehling J, Paolini M, Hubertus J. Implication of Image-Defined Risk Factors for the Extent of Surgical Resection and Clinical Outcome in Patients with Pelvic Neuroblastoma. Eur J Pediatr Surg 2021; 31:362-366. [PMID: 32862422 DOI: 10.1055/s-0040-1714658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pelvic neuroblastoma (NB) is a rare entity and occurs in 2 to 5% of all NBs. Surgery in the pelvic area is-even for the experienced oncological surgeon-technically challenging, as injuries of bladder and/or rectal innervation may carry lifelong consequences for the patient. Several studies have proven the impact of image-defined risk factors (IDRFs) for outcome, complications and extent of resection in NB; however, the specific role of IDRF in pelvic NB has not been investigated yet. MATERIALS AND METHODS Patient charts were retrospectively evaluated for International Staging System stage, IDRF status, MYCN amplification, and outcome parameters. RESULTS Between 2003 and 2019, 277 NBs were surgically resected in the department of pediatric surgery of Dr. von Hauner Children's Hospital. Out of these, 11 patients (3.9%) had pelvic NB. Evaluation of the preoperative imaging showed two patients without IDRF (stage L1) and eight patients in stage L2. One patient had stage M according to distant metastasis. Patients without IDRF underwent complete macroscopical resections, whereas complete tumor removal was not possible without mutilation in patients with IDRF. At time point of diagnosis, only patients with IDRF had functional neurological problems. Three patients developed perioperative complications; all of them had at least one IDRF. Three patients developed local recurrence during the course of the disease, all of them had at least one IDRF. CONCLUSION Our results indicate on a preliminary level the importance of IDRF as a prognostic tool for surgical removal of pelvic NB.
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Affiliation(s)
- Alexandra Froeba-Pohl
- Department of Pediatric Surgery, Munich University Hospital Dr. von Hauner Children's Hospital, Munich, Germany
| | - Dietrich von Schweinitz
- Department of Pediatric Surgery, Munich University Hospital Dr. von Hauner Children's Hospital, Munich, Germany
| | - Jakob Muehling
- Department of Pediatric Surgery, Munich University Hospital Dr. von Hauner Children's Hospital, Munich, Germany
| | - Marco Paolini
- Department of Radiology, University Hospital Munich, Munich, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, Munich University Hospital Dr. von Hauner Children's Hospital, Munich, Germany
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15
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Schmidt A, Hempel JM, Ellerkamp V, Warmann SW, Ernemann U, Fuchs J. The Relevance of Preoperative Identification of the Adamkiewicz Artery in Posterior Mediastinal Pediatric Tumors. Ann Surg Oncol 2021; 29:493-499. [PMID: 34331163 PMCID: PMC8677641 DOI: 10.1245/s10434-021-10381-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/11/2021] [Indexed: 11/18/2022]
Abstract
Background Injury to the artery of Adamkiewicz (AKA) during surgery may lead to spinal cord ischemia and severe neurologic complications. Posterior mediastinal tumors may be adjacent to AKA, but data on preoperative visualization of AKA in children are rare. This study analyzed the importance of identifying the AKA preoperatively by spinal digital subtraction angiography (DSA) in children with posterior mediastinal tumors for therapeutic procedure. Methods Between 2002 and 2021, 36 children with posterior mediastinal tumors were evaluated for surgery at the authors’ clinic. In 10 children with left-sided or bilateral tumor located at vertebral levels T8 to L1, spinal DSA was performed during preoperative workup to assess AKA. The patient and tumor characteristics as well as the diagnostic and therapeutic procedures were analyzed. Results The median age of the 10 children at examination was 69 months (range, 16–217 months). Three of the children were younger than 2 years. The tumor entities were neuroblastoma, ganglioneuroblastoma, ganglioneuroma, local relapse of a hepatocellular carcinoma, and neurofibroma. The AKA was identified in all cases, and proximity to the tumor was detected in four patients, three of whom had their planned surgery changed to irradiation. No complications occurred during spinal DSA or surgery. Conclusions In posterior mediastinal pediatric tumors, spinal DSA is a safe and reliable method for preoperative visualization of the AKA. It can show proximity to the tumor and guide the local therapy, thereby avoiding critical intra- and postoperative situations.
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Affiliation(s)
- Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Johann-Martin Hempel
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Verena Ellerkamp
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Steven W Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany.
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16
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Abdelhafeez AH, Mansfield S, Talbot L, Murphy AJ, Davidoff AM. Improving Exposure Using Thoracoscopy for Apical Thoracic Neuroblastoma Encasing the Subclavian Vessels. J Laparoendosc Adv Surg Tech A 2021; 31:589-593. [PMID: 33599543 DOI: 10.1089/lap.2020.0850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Posterolateral thoracotomy provides limited access to the thoracic apex that can result in poor visualization of subclavian vessels, their branches, and the brachial plexus. A thoracoscopic approach may overcome these limitations. Purpose: We report a thoracoscopic approach and associated technical challenges in resecting apical thoracic neuroblastoma encasing the subclavian artery. Methods: A single-institution retrospective chart review was performed (2018-2020) for patients undergoing thoracoscopic resection of apical neuroblastoma encasing the subclavian artery. Patient demographics, imaging, and hospital course were reviewed. Operative video recordings were assessed for exposure quality, technical challenges, and percentage of tumor resection. Patients were placed laterally, with three 5-mm ports triangulated to the apex. Dissection started at the tumor edge and followed along the vessel and branches. Results: Four patients (median age 2.7 years) underwent thoracoscopic apical neuroblastoma resection. Median length of stay was 2.5 days. One low-risk patient underwent resection for tumor growth during observation. One intermediate and 2 high-risk patients received neoadjuvant chemotherapy. Two patients continued having persistent vascular encasement, whereas in 1 patient the mass decreased in size and only abutted the subclavian and vertebral arteries. In 1 patient, tumor involved the brachial plexus, which was freed and preserved thoracoscopically. All cases had substantial tumor-feeding vessels branching from the subclavian artery. There was one conversion to open thoracotomy due to dense tumor adherence to the subclavian artery and vein. More than 95% resection was achieved in all cases. All patients had baseline Horner syndrome. No complications were reported. Conclusion: The thoracoscopic approach for resecting apical neuroblastoma provides optimal exposure and safe access in selected patients.
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Affiliation(s)
- Abdelhafeez H Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA.,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, USA
| | - Sara Mansfield
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA
| | - Lindsay Talbot
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA.,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA.,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA.,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, USA
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17
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Temple WC, Vo KT, Matthay KK, Balliu B, Coleman C, Michlitsch J, Phelps A, Behr S, Zapala MA. Association of image-defined risk factors with clinical features, histopathology, and outcomes in neuroblastoma. Cancer Med 2020; 10:2232-2241. [PMID: 33314708 PMCID: PMC7982630 DOI: 10.1002/cam4.3663] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/05/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Clinical, molecular, and histopathologic features guide treatment for neuroblastoma, but obtaining tumor tissue may cause complications and is subject to sampling error due to tumor heterogeneity. We hypothesized that image-defined risk factors (IDRFs) would reflect molecular features, histopathology, and clinical outcomes in neuroblastoma. METHODS We performed a retrospective cohort study of 76 patients with neuroblastoma or ganglioneuroblastoma. Diagnostic CT scans were reviewed for 20 IDRFs, which were consolidated into five IDRF groups (involvement of multiple body compartments, vascular encasement, tumor infiltration of adjacent organs/structures, airway compression, or intraspinal extension). IDRF groups were analyzed for association with clinical, molecular, and histopathologic features of neuroblastoma. RESULTS Patients with more IDRF groups had a higher risk of surgical complications (OR = 3.1, p = 0.001). Tumor vascular encasement was associated with increased risk of surgical complications (OR = 5.40, p = 0.009) and increased risk of undifferentiated/poorly differentiated histologic grade (OR = 11.11, p = 0.013). Tumor infiltration of adjacent organs and structures was associated with decreased survival (HR = 8.90, p = 0.007), MYCN amplification (OR = 9.91, p = 0.001), high MKI (OR = 6.20, p = 0.003), and increased risk of International Neuroblastoma Staging System stage 4 disease (OR = 8.96, p < 0.001). CONCLUSIONS The presence of IDRFs at diagnosis was associated with high-risk clinical, molecular, and histopathologic features of neuroblastoma. The IDRF group tumor infiltration into adjacent organs and structures was associated with decreased survival. Collectively, these findings may assist surgical planning and medical management for neuroblastoma patients.
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Affiliation(s)
- William C Temple
- Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Kieuhoa T Vo
- Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Katherine K Matthay
- Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | | | - Christina Coleman
- Department of Hematology and Oncology, UCSF Benioff Children's Hospital, Oakland, Oakland, CA, USA
| | - Jennifer Michlitsch
- Department of Hematology and Oncology, UCSF Benioff Children's Hospital, Oakland, Oakland, CA, USA
| | - Andrew Phelps
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Spencer Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew A Zapala
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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18
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Pictorial review of the clinical applications of MIBG in neuroblastoma: current practices. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00392-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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19
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Liu T, Lv Z, Xu W, Liu J, Sheng Q. Role of image-defined risk factors in predicting surgical complications of localized neuroblastoma. Pediatr Surg Int 2020; 36:1167-1172. [PMID: 32851471 PMCID: PMC7449514 DOI: 10.1007/s00383-020-04731-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the relationship between image-defined risk factors and surgical complications of localized neuroblastoma. METHODS We retrospectively evaluated 84 patients who met the inclusion criteria at our hospitals between June 2014 and June 2019. Patients' clinic data were collected and the common terminology criteria for adverse events were used to categorize complications as major (grade 3-4) or minor (grade 1-2). RESULTS Four (11.8%) out of 34 stage L1 patients and 15 (30.0%) out of 50 stage L2 patients had surgical complications (P < 0.05). Seventy patents underwent primary surgery, including all stage L1 patients and 36 stage L2 patients. There were no significant differences between the two groups regarding surgical complications or major surgical complications. Among stage L2 patients, 2 (5.6%) out of 36 who underwent primary surgery and 2 (14.3%) out of 14 who underwent secondary surgery had major surgical complications (P < 0.05). Complete tumor resection was achieved in 18 (50%) and 7 (50%) patients in each group (P > 0.05). The mean numbers of IDRFs were 2.06 and 4.29, respectively (P < 0.05). CONCLUSIONS Localized neuroblastoma patients with IDRFs have a greater surgical risk. And the number of IDRFs is not ignorable, especially in predicting major surgical complications.
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Affiliation(s)
- Tao Liu
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Zhibao Lv
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, 200040, China.
| | - Weijue Xu
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Jiangbin Liu
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Qingfeng Sheng
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, 200040, China
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20
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Liang WH, Federico SM, London WB, Naranjo A, Irwin MS, Volchenboum SL, Cohn SL. Tailoring Therapy for Children With Neuroblastoma on the Basis of Risk Group Classification: Past, Present, and Future. JCO Clin Cancer Inform 2020; 4:895-905. [PMID: 33058692 PMCID: PMC7608590 DOI: 10.1200/cci.20.00074] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/12/2022] Open
Abstract
For children with neuroblastoma, the likelihood of cure varies widely according to age at diagnosis, disease stage, and tumor biology. Treatments are tailored for children with this clinically heterogeneous malignancy on the basis of a combination of markers that are predictive of risk of relapse and death. Sequential risk-based, cooperative-group clinical trials conducted during the past 4 decades have led to improved outcome for children with neuroblastoma. Increasingly accurate risk classification and refinements in treatment stratification strategies have been achieved with the more recent discovery of robust genomic and molecular biomarkers. In this review, we discuss the history of neuroblastoma risk classification in North America and Europe and highlight efforts by the International Neuroblastoma Risk Group (INRG) Task Force to develop a consensus approach for pretreatment stratification using seven risk criteria including an image-based staging system-the INRG Staging System. We also update readers on the current Children's Oncology Group risk classifier and outline plans for the development of a revised 2021 Children's Oncology Group classifier that will incorporate INRG Staging System criteria to facilitate harmonization of risk-based frontline treatment strategies conducted around the globe. In addition, we discuss new approaches to establish increasingly robust, future risk classification algorithms that will further refine treatment stratification using machine learning tools and expanded data from electronic health records and the INRG Data Commons.
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Affiliation(s)
- Wayne H. Liang
- Department of Pediatrics and Informatics Institute, University of Alabama at Birmingham, Birmingham, AL
| | - Sara M. Federico
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Wendy B. London
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Arlene Naranjo
- Department of Biostatistics, Children’s Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL
| | - Meredith S. Irwin
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Samuel L. Volchenboum
- Department of Pediatrics and Comer Children’s Hospital, University of Chicago, Chicago, IL
| | - Susan L. Cohn
- Department of Pediatrics and Comer Children’s Hospital, University of Chicago, Chicago, IL
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21
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Ambros IM, Tonini GP, Pötschger U, Gross N, Mosseri V, Beiske K, Berbegall AP, Bénard J, Bown N, Caron H, Combaret V, Couturier J, Defferrari R, Delattre O, Jeison M, Kogner P, Lunec J, Marques B, Martinsson T, Mazzocco K, Noguera R, Schleiermacher G, Valent A, Van Roy N, Villamon E, Janousek D, Pribill I, Glogova E, Attiyeh EF, Hogarty MD, Monclair TF, Holmes K, Valteau-Couanet D, Castel V, Tweddle DA, Park JR, Cohn S, Ladenstein R, Beck-Popovic M, De Bernardi B, Michon J, Pearson ADJ, Ambros PF. Age Dependency of the Prognostic Impact of Tumor Genomics in Localized Resectable MYCN-Nonamplified Neuroblastomas. Report From the SIOPEN Biology Group on the LNESG Trials and a COG Validation Group. J Clin Oncol 2020; 38:3685-3697. [PMID: 32903140 PMCID: PMC7605396 DOI: 10.1200/jco.18.02132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
For localized, resectable neuroblastoma without MYCN amplification, surgery only is recommended even if incomplete. However, it is not known whether the genomic background of these tumors may influence outcome.
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Affiliation(s)
- Inge M Ambros
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria
| | - Gian-Paolo Tonini
- Paediatric Research Institute, Fondazione Città della Speranza, Neuroblastoma Laboratory, Padua, Italy
| | - Ulrike Pötschger
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria
| | - Nicole Gross
- Pediatric Oncology Research, Department of Pediatrics, University Hospital, Lausanne, Switzerland
| | | | - Klaus Beiske
- Department of Pathology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Ana P Berbegall
- Department of Pathology, Medical School, University of Valencia-Fundación de Investigación del Hospital Clínico Universitario de Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Jean Bénard
- Département de Biologie et de Pathologie Médicales, Service de Pathologie Moléculaire, Institut Gustave Roussy, Villejuif, France
| | - Nick Bown
- Northern Genetics Service, Newcastle upon Tyne, United Kingdom
| | - Huib Caron
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - Valérie Combaret
- Centre Léon Bérard, Laboratoire de Recherche Translationnelle, Lyon, France
| | - Jerome Couturier
- Unité de Génétique Somatique et Cytogénétique, Institut Curie, Paris, France
| | | | - Olivier Delattre
- INSERM U830, Laboratoire de Génétique et Biologie des Cancers, Paris, France
| | - Marta Jeison
- Ca-Cytogenetic Laboratory, Pediatric Hematology Oncology Department, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
| | - Per Kogner
- Childhood Cancer Research Unit, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - John Lunec
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Barbara Marques
- Centro de Genética Humana, Instituto Nacional de Saude doutor Ricardo Jorge, Lisbon, Portugal
| | - Tommy Martinsson
- Department of Clinical Genetics, Institute of Biomedicine, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Katia Mazzocco
- Department of Pathology, Istituto G. Gaslini, Genoa, Italy
| | - Rosa Noguera
- Department of Pathology, Medical School, University of Valencia-Fundación de Investigación del Hospital Clínico Universitario de Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Gudrun Schleiermacher
- INSERM U830, Laboratoire de Génétique et Biologie des Cancers, Paris, France.,Département de Pédiatrie, Institut Curie, Paris, France
| | - Alexander Valent
- Département de Biologie et de Pathologie Médicales, Service de Pathologie Moléculaire, Institut Gustave Roussy, Villejuif, France
| | - Nadine Van Roy
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Eva Villamon
- Department of Pathology, Medical School, University of Valencia-Fundación de Investigación del Hospital Clínico Universitario de Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Dasa Janousek
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria
| | - Ingrid Pribill
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria
| | - Evgenia Glogova
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria
| | - Edward F Attiyeh
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michael D Hogarty
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Tom F Monclair
- Section for Paediatric Surgery, Division of Surgery, Rikshospitalet University Hospital, Oslo, Norway
| | - Keith Holmes
- Department of Paediatric Surgery, St George's Hospital, London, UK
| | | | - Victoria Castel
- Unidad de Oncologia Pediatrica Hospital Universitario La Fe, Valencia, Spain
| | - Deborah A Tweddle
- Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Julie R Park
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA
| | - Sue Cohn
- Department of Pediatrics, The University of Chicago, Chicago, IL
| | - Ruth Ladenstein
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria.,Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Maja Beck-Popovic
- Pediatric Hematology Oncology Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Bruno De Bernardi
- Department of Paediatric Haematology and Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Jean Michon
- Département de Pédiatrie, Institut Curie, Paris, France
| | - Andrew D J Pearson
- Institute of Cancer Research, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Peter F Ambros
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria.,Department of Pediatrics, Medical University of Vienna, Vienna, Austria
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Parhar D, Joharifard S, Lo AC, Schlosser MP, Daodu OO. How well do image-defined risk factors (IDRFs) predict surgical outcomes and survival in patients with neuroblastoma? A systematic review and meta-analysis. Pediatr Surg Int 2020; 36:897-907. [PMID: 32533235 DOI: 10.1007/s00383-020-04696-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Since their introduction to the International Neuroblastoma Risk Group (INRG) staging system in 2009, the role of Image-Defined Risk Factors (IDRFs) in predicting outcomes has been studied in heterogeneous populations with varying results. We conducted a systematic review and meta-analysis in order to determine quantitative measures of precisely how well pre-treatment IDRFs predict surgical outcomes and survival. METHODS A systematic review was performed for studies between January 1990 and July 2019 that compared surgical outcomes and/or survival in pediatric neuroblastoma patients with one or more IDRFs to patients without IDRFs. Summary risk ratios (RR) and hazard ratios (HR) were calculated using a random-effects model. RESULTS 19 retrospective cohort studies were included, representing data from 1132 patients. The risk ratio (RR) of incomplete surgical resection in IDRF-positive patients compared to IDRF-negative patients was 2.45 (95% CI 1.51-3.97). The RR of surgical complications was 2.30 (95% CI 1.46-3.61). The hazard ratio (HR) for 5-year EFS was 2.08 (95% CI 2.93-4.13) while the 5-year HR for OS was 2.44 (95% CI 1.46-4.08). CONCLUSION IDRF-positive neuroblastoma patients have a higher risk of incomplete surgical resection, surgical complications, and 5-year mortality and/or relapse. Our results affirm that IDRFs remain a useful prognostic tool for neuroblastoma patients both for short and long-term outcomes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Dennis Parhar
- Department of Radiology, University of British Columbia, Gordon & Leslie Diamond Health Centre, 11th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Shahrzad Joharifard
- Departément de Chirurgie, Division de Chirurgie Pédiatrique, Université de Montréal, Montréal, QC, Canada
| | - Andrea C Lo
- Department of Radiation Oncology, BC Cancer, Vancouver, BC, Canada
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Mary-Pat Schlosser
- Department of Pediatric Medicine, Division of Immunology, Hematology/Oncology, Palliative Care and Environmental Medicine, University of Alberta, Edmonton, AB, Canada
| | - Oluwatomilayo O Daodu
- Department of Surgery, Division of Pediatric Surgery, University of Calgary, Calgary, AB, Canada
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23
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Chui C. Effects of preoperative chemotherapy on neuroblastoma with MYCN amplification: a surgeon’s perspective. WORLD JOURNAL OF PEDIATRIC SURGERY 2020; 3:e000129. [DOI: 10.1136/wjps-2020-000129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 11/04/2022] Open
Abstract
BackgroundPreoperative chemotherapy plays an important role in the surgical management of unresectable neuroblastoma. Its response to chemotherapy has been variable due to the tumor’s heterogeneity. We aimed to evaluate the effects of preoperative chemotherapy on MYCN-amplified (MYCNA) neuroblastoma that would impact on surgical resection.MethodsPatients with MYCNA neuroblastoma who received preoperative chemotherapy followed by surgical resection performed at our center were included. The tools of response evaluated included tumor volume reduction (TVR), reduction in image-defined risk factors (IDRFs), percentage tumor necrosis (Nec), and surgical complications.ResultsAmong 62 patients evaluated, mean age was 3.0 (range, 0.9–11.8) years, and primary tumors were distributed in the abdomen (n=59), pelvis (n=2), and thorax (n=1). The patients were in stages L2 (n=14) and M (n=48). Surgery was performed after median of 4 (range, 2–10) cycles of chemotherapy. On completion of preoperative chemotherapy, 41 (66.1%) patients had TVR >65%, 24 (42.9%) responded with reduced IDRFs, 47 (75.8%) tumors had Nec >50%, and 27 patients suffered 31 surgical complications. Majority (83.9%) continued to have IDRFs at surgery. IDRFs commonly encountered were encasement of renal pedicles (n=50), superior mesenteric artery (n=46), celiac axis (n=45), and aorta/vena cava (n=44), and most remained refractory to resolution. Patients with TVR >65% were associated with Nec >50% (87.5% vs 54.5%, p=0.004) and reduced IDRFs (46.3% vs 19%, p=0.035), but not with the incidence of surgical complications.ConclusionsMajority of MYCNA neuroblastomas were highly chemosensitive as they experienced high TVR, reduced IDRFs, and high Nec, and hence created favorable conditions for surgical resection. Poor responders and persistent IDRFs that were commonly refractory to preoperative chemotherapy remained a surgical challenge.
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24
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Martí-Bonmatí L, Alberich-Bayarri Á, Ladenstein R, Blanquer I, Segrelles JD, Cerdá-Alberich L, Gkontra P, Hero B, García-Aznar JM, Keim D, Jentner W, Seymour K, Jiménez-Pastor A, González-Valverde I, Martínez de Las Heras B, Essiaf S, Walker D, Rochette M, Bubak M, Mestres J, Viceconti M, Martí-Besa G, Cañete A, Richmond P, Wertheim KY, Gubala T, Kasztelnik M, Meizner J, Nowakowski P, Gilpérez S, Suárez A, Aznar M, Restante G, Neri E. PRIMAGE project: predictive in silico multiscale analytics to support childhood cancer personalised evaluation empowered by imaging biomarkers. Eur Radiol Exp 2020; 4:22. [PMID: 32246291 PMCID: PMC7125275 DOI: 10.1186/s41747-020-00150-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/24/2020] [Indexed: 03/12/2023] Open
Abstract
PRIMAGE is one of the largest and more ambitious research projects dealing with medical imaging, artificial intelligence and cancer treatment in children. It is a 4-year European Commission-financed project that has 16 European partners in the consortium, including the European Society for Paediatric Oncology, two imaging biobanks, and three prominent European paediatric oncology units. The project is constructed as an observational in silico study involving high-quality anonymised datasets (imaging, clinical, molecular, and genetics) for the training and validation of machine learning and multiscale algorithms. The open cloud-based platform will offer precise clinical assistance for phenotyping (diagnosis), treatment allocation (prediction), and patient endpoints (prognosis), based on the use of imaging biomarkers, tumour growth simulation, advanced visualisation of confidence scores, and machine-learning approaches. The decision support prototype will be constructed and validated on two paediatric cancers: neuroblastoma and diffuse intrinsic pontine glioma. External validation will be performed on data recruited from independent collaborative centres. Final results will be available for the scientific community at the end of the project, and ready for translation to other malignant solid tumours.
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Affiliation(s)
- Luis Martí-Bonmatí
- Medical Imaging Department, La Fe University and Polytechnic Hospital & Biomedical Imaging Research Group (GIBI230) at La Fe University and Polytechnic Hospital and Health Research Institute, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - Ángel Alberich-Bayarri
- Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Edificio Europa, Av. de Aragón, 30, Planta 12, 46021, Valencia, Spain
| | | | - Ignacio Blanquer
- Instituto de Instrumentación para Imagen Molecular (I3M), Universitat Politècnica de València (UPV), c\ Camino de Vera s/n, 46022, Valencia, Spain
| | - J Damian Segrelles
- Instituto de Instrumentación para Imagen Molecular (I3M), Universitat Politècnica de València (UPV), c\ Camino de Vera s/n, 46022, Valencia, Spain
| | - Leonor Cerdá-Alberich
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, Av. Fernando Abril Martorell 106, Torre E, 46026, Valencia, Spain
| | - Polyxeni Gkontra
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, Av. Fernando Abril Martorell 106, Torre E, 46026, Valencia, Spain
| | - Barbara Hero
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - J M García-Aznar
- Multiscale in Mechanical and Biological Engineering, Department of Mechanical Engineering, Universidad de Zaragoza, Zaragoza, Spain.,Aragón Institute of Engineering Research, Zaragoza, Spain
| | - Daniel Keim
- Department of Computer Science, University of Konstanz, Konstanz, Germany
| | - Wolfgang Jentner
- Department of Computer Science, University of Konstanz, Konstanz, Germany
| | | | - Ana Jiménez-Pastor
- Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Edificio Europa, Av. de Aragón, 30, Planta 12, 46021, Valencia, Spain
| | - Ismael González-Valverde
- Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Edificio Europa, Av. de Aragón, 30, Planta 12, 46021, Valencia, Spain
| | - Blanca Martínez de Las Heras
- Paediatric Oncology Unit, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, Torre G, 2 Floor, 46026, Valencia, Spain
| | - Samira Essiaf
- European Society for Paediatric Oncology, Brussels, Belgium
| | - Dawn Walker
- Department of Computer Science and Insigneo Institute of In Silico Medicine, University of Sheffield, Regent Court, 211 Portobello, Sheffield, UK
| | - Michel Rochette
- Simulation, Modelling and Engineering Software, Ansys Group, Montigny-le-Bretonneux, France
| | - Marian Bubak
- ACC Cyfronet, AGH University of Science and Technology, Sano Centre for Computational Medicine, Nawojki 11, 30-950, Kraków, Poland
| | - Jordi Mestres
- Chemotargets S.L., Carrer de Baldiri Reixac, 4-8 TI05A7 Torre I, planta 5, A7, 08028, Barcelona, Spain
| | - Marco Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Gracia Martí-Besa
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, Av. Fernando Abril Martorell 106, Torre E, 46026, Valencia, Spain
| | - Adela Cañete
- Paediatric Oncology Unit, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, Torre G, 2 Floor, 46026, Valencia, Spain
| | - Paul Richmond
- Department of Computer Science and Insigneo Institute of In Silico Medicine, University of Sheffield, Regent Court, 211 Portobello, Sheffield, UK
| | - Kenneth Y Wertheim
- Department of Computer Science and Insigneo Institute of In Silico Medicine, University of Sheffield, Regent Court, 211 Portobello, Sheffield, UK
| | - Tomasz Gubala
- ACC Cyfronet, AGH University of Science and Technology, Sano Centre for Computational Medicine, Nawojki 11, 30-950, Kraków, Poland
| | - Marek Kasztelnik
- ACC Cyfronet, AGH University of Science and Technology, Sano Centre for Computational Medicine, Nawojki 11, 30-950, Kraków, Poland
| | - Jan Meizner
- ACC Cyfronet, AGH University of Science and Technology, Sano Centre for Computational Medicine, Nawojki 11, 30-950, Kraków, Poland
| | - Piotr Nowakowski
- ACC Cyfronet, AGH University of Science and Technology, Sano Centre for Computational Medicine, Nawojki 11, 30-950, Kraków, Poland
| | | | - Amelia Suárez
- Matical Innovation, Calle de Torija, 5, 28013, Madrid, Spain
| | - Mario Aznar
- Matical Innovation, Calle de Torija, 5, 28013, Madrid, Spain
| | - Giuliana Restante
- Department of Translational Research, University of Pisa, Chair Radiodiagnostica 3, Pisa University Hospital, Via Roma 67, 56126, Pisa, Italy
| | - Emanuele Neri
- Department of Translational Research, University of Pisa, Chair Radiodiagnostica 3, Pisa University Hospital, Via Roma 67, 56126, Pisa, Italy
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25
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Zhang AA, Pan C, Xu M, Wang XX, Ye QD, Gao YJ, Tang JY. Association of image-defined risk factors, tumor resectability, and prognosis in children with localized neuroblastoma. World J Pediatr 2019; 15:572-579. [PMID: 31342464 DOI: 10.1007/s12519-019-00274-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/26/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although localized neuroblastoma has a good prognosis, some cases have undergone treatment failure or recurrence. Apart from biologic features such as MYCN status, we wondered whether some characteristics of growing tumors are prognostic, such as a well-encapsulated mass without infiltration of vital organs. We analyzed the diagnostic utility of image-defined risk factors (IDRFs) to predict successful treatment and prognosis. The overall goal was to achieve maximum cure rates for patients with localized neuroblastoma through a better understanding of clinical characteristics. METHODS We retrospectively reviewed the images of patients with localized neuroblastoma who were enrolled between June 1998 and December 2012 at a single institution in Shanghai, China. Unequivocal categorization regarding IDRFs was available in 67 patients. IDRF was assessed at diagnosis and after four cycles of neoadjuvant chemotherapy, on average. The median follow-up period was 84 months (range: 48-132 months) after diagnosis. RESULTS MRI and CT indicated a total of 177 IDRFs in these 67 patients. Logistic regression analysis revealed a highly significant negative correlation between the numbers of IDRFs and the possibility of complete removal of neuroblastoma. Intraspinal extension of the tumor, compression of the trachea, and encasement of the main artery in localized neuroblastoma were predictors for incomplete tumor resection. According to univariate analysis, ≥ 4 IDRFs and intraspinal extension of the tumor were significant indicators of poor prognosis. CONCLUSIONS The number of IDRFs was useful in predicting surgical outcome and event-free survival. The number of IDRFs should be considered in protocol planning, instead of IDRF presence or absence.
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Affiliation(s)
- An-An Zhang
- Key Laboratory of Pediatric Hematology and Oncology, Ministry of Health, Department of Pediatric Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine (SJTU-SM), Shanghai, China
| | - Ci Pan
- Key Laboratory of Pediatric Hematology and Oncology, Ministry of Health, Department of Pediatric Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine (SJTU-SM), Shanghai, China
| | - Min Xu
- Key Laboratory of Pediatric Hematology and Oncology, Ministry of Health, Department of Pediatric Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine (SJTU-SM), Shanghai, China
| | - Xiao-Xia Wang
- Key Laboratory of Pediatric Hematology and Oncology, Ministry of Health, Department of Pediatric Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine (SJTU-SM), Shanghai, China
| | - Qi-Dong Ye
- Key Laboratory of Pediatric Hematology and Oncology, Ministry of Health, Department of Pediatric Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine (SJTU-SM), Shanghai, China
| | - Yi-Jin Gao
- Key Laboratory of Pediatric Hematology and Oncology, Ministry of Health, Department of Pediatric Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine (SJTU-SM), Shanghai, China
| | - Jing-Yan Tang
- Key Laboratory of Pediatric Hematology and Oncology, Ministry of Health, Department of Pediatric Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine (SJTU-SM), Shanghai, China.
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26
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Mühling J, Eberherr C, Müller Höcker J, Grote V, von Schweinitz D, Kappler R, Fröba-Pohl A. Vessel adherent growth represents a major challenge in the surgical resection of neuroblastoma and Is associated with adverse outcome. J Pediatr Surg 2019; 54:2336-2342. [PMID: 31402147 DOI: 10.1016/j.jpedsurg.2019.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Neuroblastoma (NB) is the most common extracranial, solid tumor in childhood, with a peak incidence in children under 6 years of age. Due to its variable course of disease, which ranges from spontaneous regression to metastatic spread, NB still represents a significant therapeutic challenge. Strikingly, a certain number of NBs intraoperatively show vessel adhesion and/or infiltrative growth, which is often not visible in pre-operative imaging. We proposed the term unexpected vessel infiltration of NB (UVIN) to denote this phenomenon. UVIN represents a major surgical challenge. METHODS In this study, we determined frequency and clinical relevance of UVIN in a cohort of 100 NB-patients with subsequent correlation to several unfavorable characteristics of disease. RNA expression levels of MYCN and its co-regulated antisense transcript MYCNOS to identify markers was measured by PCR. RESULTS We found UVIN to be present in 34% of cases and significantly correlated with incomplete resection, MYCN amplification, complications, neoadjuvant therapy, tumor grade and MYCNOS expression levels. MYCN expression levels showed no significant results with UVIN. CONCLUSION Collectively, our data show that UVIN represents a frequent surgical problem associated with a poor outcome in NB patients. MYCN and MYCNOS seem to be no appropriate markers for UVIN. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jakob Mühling
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany.
| | - Corinna Eberherr
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | | | - Veit Grote
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - Dietrich von Schweinitz
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - Roland Kappler
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - Alexandra Fröba-Pohl
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
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27
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Yang T, Li H, Li J, Wu H, Hu C, Tan T, Yang J, Pan J, Zou Y. Surgical risk factors of retroperitoneal teratoma resection in children. J Pediatr Surg 2019; 54:1495-1499. [PMID: 31239061 DOI: 10.1016/j.jpedsurg.2018.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/02/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Retroperitoneal teratoma is uncommon and carries considerable surgical risks. Some preoperative clinical and radiographic features could be predictive of surgical complication risk. We aimed to identify surgical risk factors that predicted perioperative complications. METHODS Childhood retroperitoneal teratoma cases operated on at Guangzhou Women and Children's Medical Center were retrospectively reviewed. Demographic features; clinical, laboratory, radiographic, and intraoperative findings; perioperative complications; and pathology results were assessed. RESULTS Between May 2000 and December 2017, 152 childhood retroperitoneal teratomas were resected from 102 female patients (median age 5.75 months). Sixty-three patients (41%) experienced perioperative complications (79 intraoperative and 5 postoperative), including kidney excision (4 patients) and adrenal gland excision (1 patient). Among 113 patients with preoperative computed tomography/magnetic resonance images, 112 (99%), 111 (98%), and 113 (100%) demonstrated artery, vein, and organ distortion, respectively, and 28 (25%) had vessels encased by tumors. Patients with perioperative complications had more veins and organs distorted by tumors. In multivariate analysis, the numbers of vessels encased and organs distorted by tumors were significantly associated with perioperative complications (odds ratio = 1.45 and 1.69, 95% confidence interval: 1.00-2.10 and 1.19-2.41, respectively). CONCLUSIONS Retroperitoneal teratoma resection has a high perioperative complication rate. Teratomas encompassing the vasculature and distorting organs were associated with increased surgical risk. Additional studies aiming to better define the surgical approach to retroperitoneal teratoma are warranted. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Tianyou Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huixian Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiahao Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiying Wu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chao Hu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tianbao Tan
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiliang Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jing Pan
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yan Zou
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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28
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Phelps HM, Ndolo JM, Van Arendonk KJ, Chen H, Dietrich HL, Watson KD, Hilmes MA, Chung DH, Lovvorn HN. Association between image-defined risk factors and neuroblastoma outcomes. J Pediatr Surg 2019; 54:1184-1191. [PMID: 30885556 PMCID: PMC6628713 DOI: 10.1016/j.jpedsurg.2019.02.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND The current neuroblastoma (NBL) staging system employs image-defined risk factors (IDRFs) to assess numerous anatomic features, but the impact of IDRFs on surgical and oncologic outcomes is unclear. METHODS The Vanderbilt Cancer Registry identified children treated for NBL from 2002 to 2017. Tumor volume (TV) and IDRFs were measured radiographically at diagnosis and before resection. Perioperative and oncologic outcomes were evaluated. RESULTS At diagnosis of 106 NBL, 61% were IDRF positive. MYCN-amplified and undifferentiated NBL had more IDRFs than nonamplified and more differentiated tumors (p = 0.001 and p = 0.01). Of 86 NBLs resected, 43% were IDRF positive, which associated with higher stage, risk, and TV (each p < 0.001). The presence of IDRF at resection was also associated with increased blood loss (p < 0.001), longer operating times (p < 0.001), greater incidence of intraoperative complications (p = 0.03), more frequent ICU admissions postoperatively (p < 0.001), and longer hospital stays (p < 0.001). IDRF negative and positive tumors did not have significantly different rates of gross total resection (p = 0.2). Five-year relapse-free and overall survival was similar for IDRF negative and positive NBL (p = 0.9 and p = 0.8). CONCLUSIONS IDRFs at diagnosis were associated with larger, less differentiated, advanced stage, and higher risk NBL and at resection with increased operative difficulty and perioperative morbidity. However, the frequency of gross total resection and patient survival after resection were not associated with the presence of IDRFs. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hannah M. Phelps
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN,Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN,Corresponding author at: Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN 37232-9780. (H.M. Phelps)
| | - Josephine M. Ndolo
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Kyle J. Van Arendonk
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Heidi Chen
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Katherine D. Watson
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa A. Hilmes
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Dai H. Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Harold N. Lovvorn
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
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29
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Sokol E, Desai AV. The Evolution of Risk Classification for Neuroblastoma. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E27. [PMID: 30754710 PMCID: PMC6406722 DOI: 10.3390/children6020027] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
Neuroblastoma is a tumor with great clinical heterogeneity. Patients in North America are risk-stratified using a number of features including age at diagnosis, disease stage, tumor histology, MYCN status (amplified versus nonamplified), and tumor cell ploidy. In this paper, we review the evidence for utilizing these features in the risk classification of neuroblastic tumors. Additionally, we review the clinical and biologic criteria used by various cooperative groups to define low, intermediate, and high-risk disease populations in clinical trials, highlighting the differences in risk classification internationally. Finally, we discuss the development of the International Neuroblastoma Risk Group classification system, designed to begin worldwide standardization of neuroblastoma pretreatment risk classification and allow comparison of clinical trials conducted through different cooperative groups.
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Affiliation(s)
- Elizabeth Sokol
- Division of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Ami V Desai
- Department of Pediatrics, Section of Hematology, Oncology and Stem Cell Transplantation, The University of Chicago, Chicago, IL 60637, USA.
- Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, IL 60637, USA.
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30
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Luo YB, Cui XC, Yang L, Zhang D, Wang JX. Advances in the Surgical Treatment of Neuroblastoma. Chin Med J (Engl) 2018; 131:2332-2337. [PMID: 30246719 PMCID: PMC6166470 DOI: 10.4103/0366-6999.241803] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study was to review the efficacy of surgical resections in different clinical situations for a better understanding of the meaning of surgery in the treatment of neuroblastoma (NB). DATA SOURCES The online database ScienceDirect (201-2018) was utilized. The search was conducted using the keywords "neuroblastoma," "neuroblastoma resection," "neuroblastoma surgery," and "high-risk neuroblastoma." STUDY SELECTION We retrospectively analyzed of patients who underwent surgical resections in different clinical situations. The article included findings from selected relevant randomized controlled trials, systematic reviews, and meta-analyses or good-quality observational studies. Abstracts only, letters, and editorial notes were excluded. Full-text articles and abstracts were extracted and reviewed to identify key articles discussing surgery management of NB, which were then selected for critical analysis. RESULTS A total of 7800 English language articles were found containing references to NB (201-2018). The 163 articles were searched which were related to the surgical treatment of NB (201-2018). Through the analysis of these important articles, we found that the treatments of NB at low- and intermediate-risk groups were basically the same. High-risk patients remained controversial. CONCLUSIONS NB prognosis varies tremendously based on the stage and biologic features of the tumor. After reviewing the relevant literature, patients with low-risk disease are often managed with surgical resection or observation alone with tumors likely to spontaneously regress that are not causing symptoms. Intermediate patients are treated with chemotherapy with the number of cycles depending on their response as well as surgical resection of the primary tumor. High-risk patients remain controversial. Multidisciplinary intensive treatment is essential, especially for patients who received subtotal tumor resection. Minimally invasive surgery for the treatment of NBs without image-defined risk factors in low- to high-risk patients is safe and feasible and does not compromise the treatment outcome. We conclude that ≥90% resection of the primary tumor is both feasible and safe in most patients with high-risk NB. New targeted therapies are crucial to improve survival.
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Affiliation(s)
- Yan-Bing Luo
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Xi-Chun Cui
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Lin Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Da Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Jia-Xiang Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
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Alexander N, Sullivan K, Shaikh F, Irwin MS. Characteristics and management of ganglioneuroma and ganglioneuroblastoma-intermixed in children and adolescents. Pediatr Blood Cancer 2018; 65:e26964. [PMID: 29369484 DOI: 10.1002/pbc.26964] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ganglioneuromas (GNs) usually demonstrate favorable histological and clinical features. Surgery is often performed due to clinical symptoms and/or theoretical concerns that GN may transform into neuroblastoma (NB); however, several studies have identified significant GN-surgical morbidities. OBJECTIVES We compared the natural history, biological and clinical features of GN and ganglioneuroblastoma-intermixed (GNB-I) managed by surgery or observation to inform management and surveillance. PROCEDURES This retrospective study includes patients (n = 67) with histological diagnosis of GN (50/67) and GNB-I (17/67) at the Hospital for Sick Children between 1990 and 2014. Clinical, pathological features, tumor dimensions, and management were recorded. RESULTS Median age and maximal tumor diameter were 6 years (1.3-17.8) and 6.3 cm (1.4-16.9), respectively. Of the 67 patients, 46 (69%) had upfront surgery and 21 (31%) were observed. Of the 21 observed patients 4 later underwent resection. There were post-operative complications in 15 of the 50 (30%) surgical patients. The presence of imaging-defined risk factors correlated with complications (P = 0.005). Observed patients were older (median 8.4 vs. 5.3 years) and diagnosed more recently. Median growth was 0.3 cm/year and 6 of 21 had progressive disease (PD). At median follow-up of 2.2 years (0.2-14.3), all patients were alive and for those with evaluable imaging there were 27 complete and 10 partial responses, 19 stable and 6 PD. Pathology classification changed at resection for three cases, but no GN was reclassified to NB. CONCLUSIONS GN and GNB-I have a slow growth rate and resection can be associated with significant morbidity. Watch and wait approaches should be considered for some GN and GNB-I.
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Affiliation(s)
- Natasha Alexander
- Division of Haematology & Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Katie Sullivan
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Furqan Shaikh
- Division of Haematology & Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Meredith S Irwin
- Division of Haematology & Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Gauthé M, Breton M, Jehanno N, Cellier C, Michon J, Sarnacki S, Schleiermacher G, Wartski M. Prognostic impact of postoperative 123I-metaiodobenzylguanidine scintigraphy: added value of SPECT/CT and semiquantification of the uptake at the surgical site. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 64:131-138. [PMID: 29409315 DOI: 10.23736/s1824-4785.18.03031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to assess the prognostic value of postoperative 123I-MIBG scintigraphy, including systematic SPECT/CT and semiquantification of the uptake at the surgical site, in a prospective series of NB patients. METHODS Patients operated for neuroblastoma and who had benefited from postoperative 123I-MIBG scintigraphy were prospectively and consecutively included. Completeness of surgery was assessed on operative report. One month postoperative 123I-MIBG scintigraphy included planar acquisition and SPECT/CT. Semi-quantification of the 123I-MIBG SPECT/CT uptake at the surgical site was performed and ratios to reference (liver and mediastinum) areas were calculated. RESULTS Thirty patients were included between August 2012 and July 2015. Median follow-up was 36 months (range 10-98). Surgery was considered as complete in 23 patients and incomplete in 7 patients. Eight patients (26.7%) presented progressive disease (1 progression and 7 recurrences). Seven patients died (23.3%), all from NB. Six (20%) patients had positive 123I-MIBG scintigraphy (3 on planar acquisitions and 6 on SPECT/CT) and 24 patients had negative 123I-MIBG scintigraphy. Five of the 6 patients (83%) with positive 123I-MIBG scintigraphy presented progressive disease. Ratio of the uptake at the surgical site to mediastinum was strongly and independently correlated with disease-free interval and overall survival (P=0.02 and 0.01 respectively). The amplified MYCN status was also confirmed as correlated with poorer outcomes. CONCLUSIONS Postoperative 123I-MIBG scintigraphy including SPECT/CT and semiquantification of the uptake at the surgical site appeared to be a valuable prognostic tool in neuroblastoma.
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Affiliation(s)
- Mathieu Gauthé
- Unit of Nuclear Medicine, Curie Institute, Paris, France - .,Unit of Nuclear Medicine, Tenon Hospital, AP-HP, Paris, France -
| | | | - Nina Jehanno
- Unit of Nuclear Medicine, Curie Institute, Paris, France
| | | | - Jean Michon
- Unit of Pediatrics, Curie Institute, Paris, France
| | | | | | - Myriam Wartski
- Unit of Nuclear Medicine, Curie Institute, Paris, France
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Radiogenomics of neuroblastomas: Relationships between imaging phenotypes, tumor genomic profile and survival. PLoS One 2017; 12:e0185190. [PMID: 28945781 PMCID: PMC5612658 DOI: 10.1371/journal.pone.0185190] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/05/2017] [Indexed: 01/01/2023] Open
Abstract
Purpose This study investigated relationships between neuroblastomas (NBs) imaging phenotypes, tumor genomic profile and patient outcome. Patients and methods This IRB-approved retrospective observational study included 133 NB patients (73 M, 60 F; median age 15 months, range 0–151) treated in a single institution between 1998 and 2012. A consensus review of imaging (CT-scan, MRI) categorized tumors according to both the primarily involved compartment (i.e., neck, chest, abdomen or pelvis) and the sympathetic anatomical structure the tumors rose from (i.e., cervical, paravertebral or periarterial chains, or adrenal gland). Tumor shape, volume and image-defined surgical risk factors (IDRFs) at diagnosis were recorded. Genomic profiles were assessed using array-based comparative genomic hybridization and divided into three groups: “numerical-only chromosome alterations” (NCA), “segmental chromosome alterations” (SCA) and “MYCN amplification” (MNA). Statistical analyses included Kruskal–Wallis, Chi2 and Fisher’s exact tests and the Kaplan-Meier method with log-rank tests and Cox model for univariate and multivariate survival analyses. Results A significant association between the sympathetic structure origin of tumors and genomic profiles was demonstrated. NBs arising from cervical sympathetic chains were all NCA. Paravertebral NBs were NCA or SCA in 75% and 25%, respectively and none were MNA. Periarterial NBs were NCA, SCA or MNA in 33%, 56% and 11%, respectively. Adrenal NBs were NCA, SCA or MNA in 16%, 36% and 48%, respectively. Among MNA NBs, 92% originated from the adrenal gland. The sympathetic anatomical classification was significantly better correlated to overall survival than the compartmental classification (P < .0003). The tumor volume of MNA NBs was significantly higher than NCA or SCA NBs (P < .0001). Patients with initial volume less than 160 mL had significantly better overall survival (P < .009). A “single mass” pattern was significantly more frequent in NCA NBs (P = .0003). The number of IDRFs was significantly higher in MNA NBs (P < .0001). Conclusion Imaging phenotypes of neuroblastomas, including tumor origin along the sympathetic system, correlate with tumor genomic profile and patient outcome.
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Penazzi ACS, Tostes VS, Duarte AAB, Lederman HM, Caran EMM, Abib SDCV. DO THE RADIOLOGICAL CRITERIA WITH THE USE OF RISK FACTORS IMPACT THE FORECASTING OF ABDOMINAL NEUROBLASTIC TUMOR RESECTION IN CHILDREN? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:88-92. [PMID: 29257841 PMCID: PMC5543784 DOI: 10.1590/0102-6720201700020003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/09/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The treatment of neuroblastoma is dependent on exquisite staging; is performed postoperatively and is dependent on the surgeon's expertise. The use of risk factors through imaging on diagnosis appears as predictive of resectability, complications and homogeneity in staging. AIM To evaluate the traditional resectability criteria with the risk factors for resectability, through the radiological images, in two moments: on diagnosis and in pre-surgical phase. Were analyzed the resectability, surgical complications and relapse rate. METHODS Retrospective study of 27 children with abdominal and pelvic neuroblastoma stage 3 and 4, with tomography and/or resonance on the diagnosis and pre-surgical, identifying the presence of risk factors. RESULTS The mean age of the children was 2.5 years at diagnosis, where 55.6% were older than 18 months, 51.9% were girls and 66.7% were in stage 4. There was concordance on resectability of the tumor by both methods (INSS and IDRFs) at both moments of the evaluation, at diagnosis (p=0.007) and post-chemotherapy (p=0.019); In this way, all resectable patients by IDRFs in the post-chemotherapy had complete resection, and the unresectable ones, 87.5% incomplete. There was remission in 77.8%, 18.5% relapsed and 33.3% died. CONCLUSIONS Resectability was similar in both methods at both pre-surgical and preoperative chemotherapy; preoperative chemotherapy increased resectability and decreased number of risk factors, where the presence of at least one IDRF was associated with incomplete resections and surgical complications; relapses were irrelevant.
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Affiliation(s)
| | - Vivian Siqueira Tostes
- Pediatric Oncology Institute - Support Group for Adolescent and Child with Cancer (IOP-GRAACC) - Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Alexandre Alberto Barros Duarte
- Pediatric Oncology Institute - Support Group for Adolescent and Child with Cancer (IOP-GRAACC) - Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Henrique Manoel Lederman
- Postgraduate Program in Interdisciplinary Surgical Science
- Pediatric Oncology Institute - Support Group for Adolescent and Child with Cancer (IOP-GRAACC) - Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Eliana Maria Monteiro Caran
- Postgraduate Program in Interdisciplinary Surgical Science
- Pediatric Oncology Institute - Support Group for Adolescent and Child with Cancer (IOP-GRAACC) - Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Simone de Campos Vieira Abib
- Postgraduate Program in Interdisciplinary Surgical Science
- Pediatric Oncology Institute - Support Group for Adolescent and Child with Cancer (IOP-GRAACC) - Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
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Whittle SB, Smith V, Doherty E, Zhao S, McCarty S, Zage PE. Overview and recent advances in the treatment of neuroblastoma. Expert Rev Anticancer Ther 2017; 17:369-386. [PMID: 28142287 DOI: 10.1080/14737140.2017.1285230] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Children with neuroblastoma have widely divergent outcomes, ranging from cure in >90% of patients with low risk disease to <50% for those with high risk disease. Recent research has shed light on the biology of neuroblastoma, allowing for more accurate risk stratification and treatment reduction in many cases, although newer treatment strategies for children with high-risk and relapsed neuroblastoma are needed to improve outcomes. Areas covered: Neuroblastoma epidemiology, diagnosis, risk stratification, and recent advances in treatment of both newly diagnosed and relapsed neuroblastoma. Expert commentary: The identification of newer tumor targets and of novel cell-mediated immunotherapy agents may lead to novel therapeutic approaches, and clinical trials for regimens designed to target individual genetic aberrations in tumors are underway. A combination of therapeutic modalities will likely be required to improve survival and cure rates for patients with high-risk neuroblastoma.
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Affiliation(s)
- Sarah B Whittle
- a Department of Pediatrics, Section of Hematology-Oncology , Texas Children's Cancer and Hematology Centers, Baylor College of Medicine , Houston , TX , USA
| | - Valeria Smith
- a Department of Pediatrics, Section of Hematology-Oncology , Texas Children's Cancer and Hematology Centers, Baylor College of Medicine , Houston , TX , USA
| | - Erin Doherty
- a Department of Pediatrics, Section of Hematology-Oncology , Texas Children's Cancer and Hematology Centers, Baylor College of Medicine , Houston , TX , USA
| | - Sibo Zhao
- a Department of Pediatrics, Section of Hematology-Oncology , Texas Children's Cancer and Hematology Centers, Baylor College of Medicine , Houston , TX , USA
| | - Scott McCarty
- b Department of Pediatrics, Division of Hematology-Oncology , University of California San Diego, La Jolla, CA and Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital , San Diego , CA , USA
| | - Peter E Zage
- b Department of Pediatrics, Division of Hematology-Oncology , University of California San Diego, La Jolla, CA and Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital , San Diego , CA , USA
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Shirota C, Tainaka T, Uchida H, Hinoki A, Chiba K, Tanaka Y. Laparoscopic resection of neuroblastomas in low- to high-risk patients without image-defined risk factors is safe and feasible. BMC Pediatr 2017; 17:71. [PMID: 28288594 PMCID: PMC5348921 DOI: 10.1186/s12887-017-0826-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/07/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Several studies have reported that minimally invasive surgery (MIS) might be considered for resecting neuroblastomas without image-defined risk factors (IDRFs); however, there are no studies comparing the outcomes of laparotomy and laparoscopy in IDRF-negative patients. Thus, we investigated the feasibility of laparoscopic surgery and compared the two abovementioned approaches. METHODS To compare the effects of laparotomy with those of laparoscopy in patients with neuroblastomas without IDRFs, the following items were retrospectively compared: largest tumor dimension, volume of blood loss, time required to initiate postoperative feeding, locoregional recurrence rate, survival, etc. RESULTS Nine patients without IDRFs (three at low-to-medium risk and six at high risk) underwent laparotomy, and seven patients without IDRFs (two at low-to-medium risk and five at high risk) underwent laparoscopy. Median duration of surgery was 221 (130-304) and 172 (122-253) min in the laparotomy and laparoscopy groups, respectively, showing no significant difference. Median postoperative time required for resuming meal consumption was significantly longer in the laparotomy (4 days; 2-5) group than that in the laparoscopy group (3 days; 2-3; p = 0.023). Median blood loss was significantly higher in the laparotomy group (5 ml/Kg;2.6-16) than that in the laparoscopy group (2.1 ml/Kg;0.1-4.0; P = 0.037). Median follow-up period was 81 (52-94) and 21 (17-28) months, locoregional recurrence rates were 22 and 0% at 1 year, 1-year progression-free survival rates were 78 and 100%, and overall survival rates were 67 and 100% in the laparotomy and laparoscopy groups, respectively, with no significant differences. CONCLUSIONS MIS for the treatment of neuroblastomas without IDRFs in low- to high-risk patients is safe and feasible and does not compromise the treatment outcome.
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Affiliation(s)
- Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kosuke Chiba
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract
PURPOSE OF REVIEW As pediatric oncology has become more complex, designing and maintaining pediatric surgical protocols require greater expertise. The primary purpose of this review is to summarize the changes in protocols and new study findings, which have changed surgical practice for children with solid tumors. RECENT FINDINGS The most common solid tumors treated by surgery are reviewed. There are new methods of surgical techniques such as the use of sentinel lymph node techniques for the assessment of lymph nodes in pediatric sarcoma. New studies showing excellent outcomes for the nonoperative treatment for young patients with neuroblastoma are discussed. Surgical quality with the prevention of tumor rupture and the assessment of lymph nodes is essential for good outcomes in patients with Wilm's tumor. The international collaborations within germ cell and liver tumors have provided excellent new study regimens and welcomed a new era of studies that are robust and have the power to change the outcomes for these rare tumors. SUMMARY Surgical practice is evolving with the molecular advances in pediatric oncology. Technical advances and quality improvement endeavors to ensure protocol adherence are essential. International partnerships have allowed for greater advances particularly for rare tumors and improve overall surgical outcomes.
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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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Manson DE. Magnetic resonance imaging of the mediastinum, chest wall and pleura in children. Pediatr Radiol 2016; 46:902-15. [PMID: 27229507 DOI: 10.1007/s00247-016-3598-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/10/2016] [Accepted: 02/25/2016] [Indexed: 02/03/2023]
Abstract
The acceptance of applications for the use of chest MRI in children has been somewhat slow and selective. The use of MRI to image chest wall lesions is likely the most common and widely used indication, aside from the widespread and somewhat sophisticated use of MRI in imaging the cardiovascular structures of the chest. In this respect, fairly standard variations of T1-W, T2-W and contrast-enhanced imaging can be used, similar to the sequences used for musculoskeletal lesions elsewhere in the body. Imaging of the anterior mediastinal masses should be performed in conjunction with a detailed pre-test clinical examination to determine potential cardiovascular compromise. MRI in the setting of middle mediastinal adenopathy, congenital mediastinal cysts or posterior mediastinal masses, however, has been shown to be more effective and more comprehensive than multidetector CT. Although sonographic imaging is the initial modality of choice for pleural abnormalities, MR imaging is extremely effective and clinically useful in the setting of a potentially ambiguous sonographic examination. Faster imaging protocols are likely to increase the acceptance of MRI to replace multidetector CT for many pediatric chest lesions.
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Affiliation(s)
- David E Manson
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Fumino S, Kimura K, Iehara T, Nishimura M, Nakamura S, Souzaki R, Nishie A, Taguchi T, Hosoi H, Tajiri T. Validity of image-defined risk factors in localized neuroblastoma: A report from two centers in Western Japan. J Pediatr Surg 2015; 50:2102-6. [PMID: 26388125 DOI: 10.1016/j.jpedsurg.2015.08.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Japanese Neuroblastoma Study Group (JNBSG) has been employing image-defined risk factors (IDRFs) since 2010. However, the report from INRG in 2011 supplemented description stating that isolated contact is considered to be IDRF-positive only in renal vessels. The aim of this study was to evaluate the validity of IDRFs by comparing the previous (PG) and new guidelines (NG). METHODS IDRFs of patients with localized neuroblastoma treated at two centers in Western Japan from 2002 to 2013 were retrospectively reviewed by radiologists. RESULTS 47 neuroblastomas (abdomen 38, pelvis 2, mediastinum 7) were evaluated. For abdominal neuroblastomas, IDRFs were present in 15/38 (39.5%) using PG and in 31/38 (81.6%) using NG. Moreover, the IDRF-positive rate increased from 26.7% (4/15) to 80.0% (12/15) in 15 cases diagnosed during mass screening. Of the IDRF-positive cases, complete primary resection was achieved in 2/15 (13.3%) using PG and 17/31 patients (54.8%) using NG. There were two major surgical renal complications in the IDRF-positive cases based on the use of either guidelines, and the specificity decreased from 64% to 19%. CONCLUSIONS According to NG, the IDRF-positive rate increased, and the resection rate decreased. NG may overestimate surgical risks, leading to unnecessary chemotherapy and a prolonged hospital stay.
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Affiliation(s)
- Shigehisa Fumino
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Koseki Kimura
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoko Iehara
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Motoki Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto Japan
| | - Satoaki Nakamura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto Japan
| | - Ryota Souzaki
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihiro Nishie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hajime Hosoi
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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La Quaglia MP. The role of primary tumor resection in neuroblastoma: When and how much? Pediatr Blood Cancer 2015; 62:1516-7. [PMID: 25982246 DOI: 10.1002/pbc.25585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Michael P La Quaglia
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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