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Barnbrock AE, Luckowitsch M, Schmidt S, Buus-Gehrig C, Koscher L, Becker M, Vokuhl C, Klingebiel T, Lehrnbecher T, Bochennek K. Progression and Relapse of Pediatric Soft Tissue Sarcoma: Individualized Approach of Treatment - Experience from a Major Pediatric Cancer Center in Europe. KLINISCHE PADIATRIE 2023; 235:360-365. [PMID: 37494132 DOI: 10.1055/a-2103-2781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND The outcome of children with refractory or relapsed soft tissue sarcoma (STS) is extremely poor. Whereas larger clinical trials evaluated specific treatment modalities, real-life data on individual multimodal therapeutic strategies, given alone or in combination, are scarce. PATIENTS AND METHODS We retrospectively analyzed the clinical course of 18 pediatric patients with progression of or relapsed STS treated between 2008 and 2018 in our institution. RESULTS A total of 18 patients (median age 12.4 years) suffered from progression or relapse of alveolar (n=7), embryonal (n=5), undifferentiated (n=2) rhabdomyosarcoma or desmoplastic small round cell tumor (n=4). 14 patents had an initial stage IV disease. All but one patient died. Median survival was 12.5 months. Shortest survival was seen in patients with systemic progression of the disease, longest in patients with local relapse. Patients with an Oberlin score<2 at the time of relapse had a significant longer time of survival than those with a score≥2. No significant advantage of a specific therapeutic modality was observed. DISCUSSION We critically analyzed the clinical course in the real-life setting, in which various treatment options were applied to an individual patient according to the best of available data. We observed that some patients died within a short period of time despite multiple treatment modalities, which underlines the need for better prognostic parameters. CONCLUSION In addition to well characterized clinical factors such as local or systemic relapse, the Oberlin score could be helpful in counselling patients and their families for choosing the best strategy of care.
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Affiliation(s)
- Anke Elisabeth Barnbrock
- Pediatric Oncology, Hospital of the Goethe University Frankfurt Centre for Paediatrics and Adolescent Medicine, Frankfurt am Main, Germany
| | - Marie Luckowitsch
- Pediatric Oncology, Hospital of the Goethe University Frankfurt Centre for Paediatrics and Adolescent Medicine, Frankfurt am Main, Germany
| | - Stanislaw Schmidt
- Pediatric Oncology, Hospital of the Goethe University Frankfurt Centre for Paediatrics and Adolescent Medicine, Frankfurt am Main, Germany
| | - Constanze Buus-Gehrig
- Pediatric Oncology, Hospital of the Goethe University Frankfurt Centre for Paediatrics and Adolescent Medicine, Frankfurt am Main, Germany
| | - Leila Koscher
- Pediatric Oncology, Hospital of the Goethe University Frankfurt Centre for Paediatrics and Adolescent Medicine, Frankfurt am Main, Germany
| | - Martina Becker
- Pediatric Oncology, Hospital of the Goethe University Frankfurt Centre for Paediatrics and Adolescent Medicine, Frankfurt am Main, Germany
| | - Christian Vokuhl
- Department of Pathology, Section Pediatric Pathology, University Bonn, Germany
| | - Thomas Klingebiel
- Pediatric Oncology, Hospital of the Goethe University Frankfurt Centre for Paediatrics and Adolescent Medicine, Frankfurt am Main, Germany
| | - Thomas Lehrnbecher
- Pediatric Oncology, Hospital of the Goethe University Frankfurt Centre for Paediatrics and Adolescent Medicine, Frankfurt am Main, Germany
| | - Konrad Bochennek
- Pediatric Oncology, Hospital of the Goethe University Frankfurt Centre for Paediatrics and Adolescent Medicine, Frankfurt am Main, Germany
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2
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Casanova M, Bautista F, Campbell-Hewson Q, Makin G, Marshall LV, Verschuur AC, Cañete Nieto A, Corradini N, Ploeger BA, Brennan BJ, Mueller U, Zebger-Gong H, Chung JW, Geoerger B. Regorafenib plus Vincristine and Irinotecan in Pediatric Patients with Recurrent/Refractory Solid Tumors: An Innovative Therapy for Children with Cancer Study. Clin Cancer Res 2023; 29:4341-4351. [PMID: 37606641 PMCID: PMC10618645 DOI: 10.1158/1078-0432.ccr-23-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/17/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE This phase Ib study defined the safety, MTD, and recommended phase II dose (RP2D) of regorafenib combined with vincristine and irinotecan (VI). Secondary objectives were evaluation of antitumor activity and pharmacokinetics (PK) of regorafenib and irinotecan. PATIENTS AND METHODS Patients aged 6 months to <18 years with relapsed/refractory solid malignancies [≥50% with rhabdomyosarcoma (RMS)] received regorafenib (starting dose 72 mg/m2/day) concomitantly or sequentially with vincristine 1.5 mg/m2 on days 1 and 8, and irinotecan 50 mg/m2 on days 1-5 (21-day cycle). Adverse events (AE) and tumor response were assessed. PK (regorafenib and irinotecan) were evaluated using a population PK model. RESULTS We enrolled 21 patients [median age, 10 years; 12, RMS; 5, Ewing sarcoma (EWS)]. The MTD/RP2D of regorafenib in the sequential schedule was 82 mg/m2. The concomitant dosing schedule was discontinued because of dose-limiting toxicities in 2 of 2 patients treated. Most common grade 3/4 (>30% of patients) AEs were neutropenia, anemia, thrombocytopenia, and leukopenia. The overall response rate was 48% and disease control rate [complete response (CR)/partial response/stable disease/non-CR/non-progressive disease] was 86%. Median progression-free survival was 7.0 months [95% confidence interval (CI), 2.9-14.8] and median overall survival was 8.7 months (95% CI, 5.5-16.3). When combined with VI, regorafenib PK was similar to single-agent PK in children and adults (treated with regorafenib 160 mg/day). CONCLUSIONS Regorafenib can be combined sequentially with standard dose VI in pediatric patients with relapsed/refractory solid tumors with appropriate dose modifications. Clinical activity was observed in patients with RMS and EWS (ClinicalTrials.gov NCT02085148).
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Affiliation(s)
- Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francisco Bautista
- Department of Paediatric Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Guy Makin
- Division of Cancer Sciences, School of Medical Sciences, University of Manchester and Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Lynley V. Marshall
- Paediatric and Adolescent Oncology Drug Development Team, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Arnauld C. Verschuur
- Department of Pediatric Haematology-Oncology, La Timone Children's Hospital, AP-HM, Marseille, France
| | - Adela Cañete Nieto
- Unidad de Oncología Pediátrica, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - Nadège Corradini
- Hematology and Oncology Pediatric Institute, Léon Bérard Center, Lyon, France
| | - Bart A. Ploeger
- Pharmacometrics/Modelling and Simulation, Bayer AG, Berlin, Germany
| | | | - Udo Mueller
- Department of Statistics, ClinStat GmbH, Cologne, Germany
| | - Hong Zebger-Gong
- Medical Affairs and Pharmacovigilance, Bayer AG, Berlin, Germany
| | - John W. Chung
- Clinical Development Oncology, Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, INSERM U1015, Université Paris-Saclay, Villejuif, France
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3
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Developments in the Surgical Approach to Staging and Resection of Rhabdomyosarcoma. Cancers (Basel) 2023; 15:cancers15020449. [PMID: 36672397 PMCID: PMC9857078 DOI: 10.3390/cancers15020449] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Although survival after rhabdosarcoma treatment has improved over the years, one third of patients still develop locoregional relapse. This review aims to highlight developments pertaining to staging and local treatment of specific RMS tumor sites, including head and neck, chest/trunk, bladder-prostate, female genito-urinary, perianal, and extremity sites.
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4
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Hindi N, Carrillo-García J, Blanco-Alcaina E, Renshaw M, Luna P, Durán J, Jiménez N, Sancho P, Ramos R, Moura DS, Martín-Broto J. Platinum-Based Regimens Are Active in Advanced Pediatric-Type Rhabdomyosarcoma in Adults and Depending on HMGB1 Expression. Int J Mol Sci 2023; 24:ijms24010856. [PMID: 36614297 PMCID: PMC9821763 DOI: 10.3390/ijms24010856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023] Open
Abstract
Rhabdomyosarcoma (RMS) in adults is a rare and aggressive disease, which lacks standard therapies for relapsed or advanced disease. This retrospective study aimed to describe the activity of BOMP-EPI (bleomycin, vincristine, methotrexate and cisplatin alternating with etoposide, cisplatin and ifosfamide), an alternative platinum-based regimen, in adult patients with relapsed/metastatic RMS. In the study, 10 patients with RMS with a median age at diagnosis of 20.8 years and a female/male distribution of 6/4 received a mean of 2.5 cycles of BOMP-EPI. The best RECIST response was a complete response in 1/10 (10%) patients, a partial response in 5/10 (50%), stable disease in 3/10 (30%) and progression in 1/10 (10%). With a median follow-up in the alive patients from the start of therapy of 30.5 months (15.7-258), all patients progressed with a median progression-free survival of 8.47 months (95% CI 8.1-8.8), and 7/10 patients died with a median overall survival of 24.7 months (95% CI 13.7-35.6). BOMP-EPI was an active chemotherapy regimen in adults with pediatric-type metastatic RMS, with outcomes in terms of survival that seem superior to what was expected for this poor-prognosis population. Low HMGB1 expression level was identified as a predictive factor of better response to this treatment.
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Affiliation(s)
- Nadia Hindi
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), 28040 Madrid, Spain
- Medical Oncology Department, University Hospital General de Villalba, 28400 Madrid, Spain
- Medical Oncology Department, University Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Jaime Carrillo-García
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), 28040 Madrid, Spain
- Medical Oncology Department, University Hospital General de Villalba, 28400 Madrid, Spain
| | - Elena Blanco-Alcaina
- Institute of Biomedicine of Seville (IBIS), HUVR-CSIC-University of Seville, 41013 Seville, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Renshaw
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), 28040 Madrid, Spain
- Medical Oncology Department, University Hospital General de Villalba, 28400 Madrid, Spain
| | - Pablo Luna
- Medical Oncology Department, University Hospital Son Espases, 07210 Palma, Spain
| | - José Durán
- Medical Oncology Department, University Hospital Son Espases, 07210 Palma, Spain
| | - Natalia Jiménez
- Medical Oncology Department, San Vicente de Paúl Hospital, Heredia 40101, Costa Rica
| | - Pilar Sancho
- Medical Oncology Department, University Hospital Virgen del Rocío, 41013 Seville, Spain
| | - Rafael Ramos
- Pathology Department, University Hospital Son Espases, 07210 Palma, Spain
| | - David S. Moura
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), 28040 Madrid, Spain
- Medical Oncology Department, University Hospital General de Villalba, 28400 Madrid, Spain
| | - Javier Martín-Broto
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), 28040 Madrid, Spain
- Medical Oncology Department, University Hospital General de Villalba, 28400 Madrid, Spain
- Medical Oncology Department, University Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-910-908-102 (ext. 52831)
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5
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Bergamaschi L, Chiaravalli S, Livellara V, Sironi G, Puma N, Nigro O, Gattuso G, Luksch R, Terenziani M, Spreafico F, Meazza C, Podda M, Biassoni V, Schiavello E, Hovsepyan S, Morosi C, Vennarini S, Massimino M, Casanova M, Ferrari A. Relapse after nonmetastatic rhabdomyosarcoma: Salvage rates and prognostic variables. Pediatr Blood Cancer 2023; 70:e30050. [PMID: 36215173 DOI: 10.1002/pbc.30050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with relapsing rhabdomyosarcoma (RMS) pose a therapeutic challenge, and the survival rate is reportedly poor. We describe a retrospective series of relapsing RMS patients treated at a referral center for pediatric sarcoma, investigating the pattern of relapse, salvage rates, and factors correlating with final outcomes. METHODS The analysis concerned 105 patients <21 years old treated from 1985 to 2020 with initially localized RMS at first relapse. For risk-adapted stratification purposes, patient outcomes were examined using univariable and multivariable analyses based on patients' clinical features at first diagnosis, first-line treatments, clinical findings at first relapse, and second-line treatments. RESULTS First relapses occurred 0.08-4.8 years (median 1 year) following initial diagnosis and were local/locoregional in 59% of cases. Treatment at first relapse included chemotherapy in all but two cases, radiotherapy in 38, and surgery in 21. Median event-free survival (EFS) after first relapse was 4 months, while 5-year EFS was 16.3%; median overall survival (OS) was 9 months, while 5-year OS was 16.7%. Several variables influenced survival rates. Considering only clinical findings and treatment at relapse, Cox's multivariable analysis showed that OS correlated significantly with time to relapse, radiotherapy administered at relapse, response to chemotherapy, and whether a second remission was achieved. CONCLUSION Survival following first relapse of patients with localized RMS at initial diagnosis is poor. The variables found to influence survival can be utilized in a risk-adapted model to estimate the chances of salvage to guide decisions for second-line treatments.
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Affiliation(s)
- Luca Bergamaschi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Virginia Livellara
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Shushan Hovsepyan
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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The Role of a Multidisciplinary Team in the Diagnosis and Treatment of Bone and Soft Tissue Sarcomas: A Single-Center Experience. J Pers Med 2022; 12:jpm12122079. [PMID: 36556299 PMCID: PMC9782466 DOI: 10.3390/jpm12122079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Bone and soft tissue sarcomas with complex and varied clinical, imaging, and pathological characteristics cannot be diagnosed and treated by a single discipline, as each discipline has some limitations. This study aimed to explore the role of a multidisciplinary team (MDT) in the diagnosis and treatment of bone and soft tissue sarcomas over the past four consecutive years. The subjects were 269 patients discussed during MDT meetings at a Bone and Soft Tissue Sarcomas Center in South China. The diagnosis, relapse diagnosis, unplanned resection, management of pulmonary nodules, and treatment of refractory and advanced tumors were compared to similar data provided in the literature to (i) determine whether the MDT significantly affected the diagnosis and treatment of bone and soft tissue sarcomas, and (ii) explore trends in the types of patients with bone and soft tissue sarcomas and treatment decision-making since the establishment of the MDT. Results revealed that the MDT significantly improved preoperative diagnostic accuracy for patients with bone and soft tissue sarcomas; the accuracy of diagnosis and relapse diagnosis by the MDT reached 95.42% and 100%, respectively. After an MDT discussion, the positive pathology rate for extended resection after unplanned resection was 81.2%. The overall accuracy of the MDT in determining the nature of pulmonary nodules was 87.1-91.9%. For patients presenting with pulmonary nodules in osteosarcoma, no statistically significant difference in survival was shown between cases discussed by the MDT and those without an MDT discussion (p = 0.5751). Collectively, the MDT can play a positive role in accurate preoperative diagnosis, relapse diagnosis, the decision to extend resection after an unplanned resection, and the diagnostic accuracy of pulmonary nodules.
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7
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Park M, Lee JA, Jin HY, Kim JY, Park JW, Kim JH, Kang HG, Park SY, Park EY, Park HJ, Park BK. Clinical characteristics and long-term outcomes of rhabdomyosarcoma in Korean children, adolescents and young adults: a single-center experience. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04192-x. [DOI: 10.1007/s00432-022-04192-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022]
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8
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Meng Z, Lin D, Liu C, Wang G, Sun N. Vaginal tumours in childhood: a descriptive analysis from a large paediatric medical centre. Pediatr Surg Int 2022; 38:927-934. [PMID: 35325284 DOI: 10.1007/s00383-022-05085-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Malignant tumours of the vagina are very rare in children. The purpose of this study was to retrospectively analyse the clinical presentation, treatment, and outcome of vaginal tumours in children treated in a single institution. METHODS This study retrospectively analysed the clinical data of children diagnosed with vaginal malignant tumours who were admitted to the Beijing Children's Hospital of Capital Medical University from January 2007 to December 2020 and followed these patients to observe their prognoses and outcomes. RESULTS During 13 years, a total of 33 children were included in this study, including 13 children with rhabdomyosarcoma and 20 children with endodermal sinus tumours. The average age at diagnosis was 20.4 months. The main clinical manifestations were vaginal bleeding and protruding masses. Of the 13 children with vaginal rhabdomyosarcoma, 12 were treated with multidrug chemotherapy combined with conservative tumour resection, and their tumours completely resolved; only one child underwent vaginectomy and hysterectomy. Twenty children with vaginal endodermal sinus received PEB chemotherapy. Among these patients, the tumour disappeared after chemotherapy in 12 children, and the remaining nodular tumour foci in 8 children were confirmed to be necrotic tissue by pathology. CONCLUSION Our research confirms that chemotherapy combined with conservative surgical treatment is effective for treating children with vaginal malignancies.
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Affiliation(s)
- Zhaoyi Meng
- Department of Urology, Beijing Children's Hospital Affiliated With Capital Medical University, National Center for Children's Health, No. 56 Nanlishilu Rd, West District, Beijing, China
| | - Defu Lin
- Department of Urology, Beijing Children's Hospital Affiliated With Capital Medical University, National Center for Children's Health, No. 56 Nanlishilu Rd, West District, Beijing, China
| | - Chao Liu
- Department of Urology, Beijing Children's Hospital Affiliated With Capital Medical University, National Center for Children's Health, No. 56 Nanlishilu Rd, West District, Beijing, China
| | - Guanan Wang
- Department of Urology, Beijing Children's Hospital Affiliated With Capital Medical University, National Center for Children's Health, No. 56 Nanlishilu Rd, West District, Beijing, China
| | - Ning Sun
- Department of Urology, Beijing Children's Hospital Affiliated With Capital Medical University, National Center for Children's Health, No. 56 Nanlishilu Rd, West District, Beijing, China.
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9
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Lak NS, Voormanns TL, Zappeij-Kannegieter L, van Zogchel LM, Fiocco M, van Noesel MM, Merks JH, van der Schoot CE, Tytgat GA, Stutterheim J. Improving Risk Stratification for Pediatric Patients with Rhabdomyosarcoma by Molecular Detection of Disseminated Disease. Clin Cancer Res 2021; 27:5576-5585. [PMID: 34285060 PMCID: PMC9401561 DOI: 10.1158/1078-0432.ccr-21-1083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/20/2021] [Accepted: 07/15/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Survival of children with rhabdomyosarcoma that suffer from recurrent or progressive disease is poor. Identifying these patients upfront remains challenging, indicating a need for improvement of risk stratification. Detection of tumor-derived mRNA in bone marrow (BM) and peripheral blood (PB) using reverse-transcriptase qPCR (RT-qPCR) is a more sensitive method to detect disseminated disease. We identified a panel of genes to optimize risk stratification by RT-qPCR. EXPERIMENTAL DESIGN Candidate genes were selected using gene expression data from rhabdomyosarcoma and healthy hematologic tissues, and a multiplexed RT-qPCR was developed. Significance of molecular disease was determined in a cohort of 99 Dutch patients with rhabdomyosarcoma (72 localized and 27 metastasized) treated according to the European pediatric Soft tissue sarcoma Study Group (EpSSG) RMS2005 protocol. RESULTS We identified the following 11 rhabdomyosarcoma markers: ZIC1, ACTC1, MEGF10, PDLIM3, SNAI2, CDH11, TMEM47, MYOD1, MYOG, and PAX3/7-FOXO1. RT-qPCR was performed for this 11-marker panel on BM and PB samples from the patient cohort. Five-year event-free survival (EFS) was 35.5% [95% confidence interval (CI), 17.5%-53.5%] for the 33/99 RNA-positive patients, versus 88.0% (95% CI, 78.9%-97.2%) for the 66/99 RNA-negative patients (P < 0.0001). Five-year overall survival (OS) was 54.8% (95% CI, 36.2%-73.4%) and 93.7% (95% CI, 86.6%-100.0%), respectively (P < 0.0001). RNA panel positivity was negatively associated with EFS (Hazard Ratio = 9.52; 95% CI, 3.23-28.02), whereas the RMS2005 risk group stratification was not, in the multivariate Cox regression model. CONCLUSIONS This study shows a strong association between PCR-based detection of disseminated disease at diagnosis with clinical outcome in pediatric patients with rhabdomyosarcoma, also compared with conventional risk stratification. This warrants further validation in prospective trials as additional technique for risk stratification.
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Affiliation(s)
- Nathalie S.M. Lak
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Sanquin Research, Amsterdam, the Netherlands
| | | | | | - Lieke M.J. van Zogchel
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Sanquin Research, Amsterdam, the Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Mathematical Institute, University of Leiden, Leiden, the Netherlands.,Department of Data Science, Medical Statistics Section, Leiden University Medical Centre, University of Leiden, Leiden, the Netherlands
| | - Max M. van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | - Godelieve A.M. Tytgat
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Sanquin Research, Amsterdam, the Netherlands
| | - Janine Stutterheim
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Sanquin Research, Amsterdam, the Netherlands.,Corresponding Author: Janine Stutterheim, Pediatric Oncology/Hematology, Princess Máxima Center for Pediatric Oncology/Hematology, Utrecht, Utrecht, 3584 CS, the Netherlands. E-mail:
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10
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Tsakatikas S, Papageorgiou G, Fioretzaki R, Kosmas C. An overview of current results with the vincristine-irinotecan-temozolomide combination with or without bevacizumab in pediatric, adolescence and adult solid tumors. Crit Rev Oncol Hematol 2021; 166:103457. [PMID: 34428555 DOI: 10.1016/j.critrevonc.2021.103457] [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: 10/17/2020] [Revised: 01/02/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
Malignant tumors in young patients present a significant therapeutic challenge for physicians, partially due to their rarity and a relative lack of data, at least compared to adult tumors. As a result, there is an urgent need to explore new possible therapeutic regimens, either by introducing novel agents or by exploring combinations of existing agents. Vincristine, Temozolomide and Irinotecan are chemotherapeutic drugs which have emerged over the last six decades as monotherapy or as part of therapeutic regimens in various solid tumors. Combining these agents can yield strong synergistic effects, as suggested by preclinical data and results from clinical trials. Furthermore, adding novel molecules, such as anti-VEGF factor Bevacizumab to the aforementioned regimens, has shown efficacy in a limited number of trials, which are thoroughly analyzed throughout this review. Data presented throughout this paper suggest that VIT(b) regimen should be further explored in solid tumors in pediatric and adolescent patients.
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Affiliation(s)
- Sergios Tsakatikas
- Department of Medical Oncology & Hematopoietic Cell Transplant Unit, "Metaxa" Memorial Cancer Hospital, 18537, Piraeus, Greece.
| | - George Papageorgiou
- Department of Medical Oncology & Hematopoietic Cell Transplant Unit, "Metaxa" Memorial Cancer Hospital, 18537, Piraeus, Greece.
| | - Rodanthi Fioretzaki
- Department of Medical Oncology & Hematopoietic Cell Transplant Unit, "Metaxa" Memorial Cancer Hospital, 18537, Piraeus, Greece.
| | - Christos Kosmas
- Department of Medical Oncology & Hematopoietic Cell Transplant Unit, "Metaxa" Memorial Cancer Hospital, 18537, Piraeus, Greece.
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11
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Gupta AA. Reasonable Attempt at a Randomized Trial in Relapsed Rhabdomyosarcoma. J Clin Oncol 2021; 39:2977-2978. [PMID: 34383578 DOI: 10.1200/jco.21.01631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Abha A Gupta
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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12
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Defachelles AS, Bogart E, Casanova M, Merks JHM, Bisogno G, Calareso G, Gallego Melcon S, Gatz SA, Le Deley MC, McHugh K, Probst A, Rocourt N, van Rijn RR, Wheatley K, Minard-Colin V, Chisholm JC. Randomized Phase II Trial of Vincristine-Irinotecan With or Without Temozolomide, in Children and Adults With Relapsed or Refractory Rhabdomyosarcoma: A European Paediatric Soft tissue Sarcoma Study Group and Innovative Therapies for Children With Cancer Trial. J Clin Oncol 2021; 39:2979-2990. [PMID: 34343032 DOI: 10.1200/jco.21.00124] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The VIT-0910 trial was conducted to evaluate efficacy and safety of the vincristine-irinotecan combination with and without temozolomide (VIT and VI, respectively) in relapsed or refractory rhabdomyosarcoma (RMS). METHODS In this randomized European phase II trial, patients age 0.5-50 years received 21-day cycles combining vincristine (1.5 mg/m2 once a day on day 1 and day 8) and irinotecan (50 mg/m2 once a day from day 1 to day 5) with and without temozolomide (125 mg/m2 once a day from day 1 to day 5 and 150 mg/m2 once a day from cycle 2), until progression or unacceptable toxicity. The primary end point was objective response rate after two cycles. Secondary end points included best response, progression-free survival, overall survival, and adverse events. A Simon 2-stage design was initially planned to separately analyze 40 patients/arm. After amendment, the trial sample size was increased to 120 and a comparison between arms, adjusted for confounding factors, was added to the statistical plan (ClinicalTrials.gov, NCT01355445). RESULTS Overall, 120 patients (60 per arm) were recruited in 37 European centers. The median age was 11 years (range, 0.75-45); 89% of patients had a relapsed RMS. The objective response rate was 44% (24 of 55 evaluable patients) for VIT versus 31% (18 of 58) for VI (adjusted odds ratio, 0.50; 95% CI, 0.22 to 1.12; P = .09). The VIT arm achieved significantly better overall survival (adjusted hazard ratio, 0.55; 95% CI, 0.35 to 0.84; P = .006) compared with VI, with consistent progression-free survival results (adj-hazard ratio, 0.68; 95% CI, 0.46 to 1.01; P = .059). Overall, patients experienced adverse events ≥ grade 3 more frequently with VIT than VI (98% v 78%, respectively; P = .009), including a significant excess of hematologic toxicity (81% v 61%; P = .025). CONCLUSION The addition of temozolomide to VI improved chemotherapy efficacy for patients with relapsed RMS, with manageable increase in toxicity. VIT is considered the new standard treatment in these patients in the European paediatric Soft Tissue Sarcoma Group and will be the control arm in the next randomized trial.
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Affiliation(s)
- Anne-Sophie Defachelles
- Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | | | | | - Gianni Bisogno
- Department of Women and Children Health, University Hospital of Padova, Padova, Italy
| | | | | | - Susanne Andrea Gatz
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Kieran McHugh
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | | | | | - Rick R van Rijn
- Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Véronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Julia C Chisholm
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
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13
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Zloto O, Minard‐Colin V, Boutroux H, Brisse HJ, Levy C, Kolb F, Bolle S, Carton M, Helfre S, Orbach D. Second-line therapy in young patients with relapsed or refractory orbital rhabdomyosarcoma. Acta Ophthalmol 2021; 99:334-341. [PMID: 32833335 DOI: 10.1111/aos.14596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Localized orbital rhabdomyosarcoma (oRMS) has an overall favourable prognosis with more than 90% of survival. Little is known about the best strategy in recurrent/refractory (R/R) cases. The purpose is to examine the characteristics of patients with R/R-oRMS, focusing on local therapy. METHODS This is bicentric retrospective study. Analysis is of young patients (<30 years) with R/R-oRMS who were treated from 1989 to 2018 at the Institut Curie and Gustave Roussy Cancer Campus, France. RESULTS Twenty-seven out of 162 patients (17%) with oRMS presented with R/R disease. 6 of these patients had alveolar RMS (22%), 3 of whom had initial parameningeal extension (11%). During first-line treatment, 18 patients (67%) had orbital radiotherapy. Median age at R/R was 10 years (ranges: 4-28) after a delay of 19 months from diagnosis (ranges: 3-40). Tumoral events were local relapses (22 cases), local progression (3 cases) or regional relapses (2 cases). Second-line treatments included chemotherapy (27 cases), radiotherapy (16 cases), surgery (exenteration; 8 cases) and metastasis/ nodal removal (3 cases). After a median follow-up of 99 months (range: 10-306), 4 patients died and 23 are in complete remission (CR) without treatment. One patient had subsequent relapse treated with exenteration and brachytherapy until a new tumour remission. Five-year event-free and overall survivals after first tumour event are, respectively, 84.4% (95% confidence interval: 71.5%-98.8%) and 85.8% (95% confidence interval: 72.1%-100.0%) CONCLUSION: R/R-oRMS is a rare situation. Second-line therapy is efficient in this location, sometime at the cost of lifesaving mutilating surgery. Second-line local therapy needs therefore to consider local radiotherapy if possible or complete wide surgery.
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Affiliation(s)
- Ofira Zloto
- Goldschleger Eye Institute Sheba Medical Center Affiliated with The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer) Institut Curie PSL University Paris France
| | - Veronique Minard‐Colin
- Pediatric Adolescent Young Adult Department Institut de Cancérologie Gustave Roussy Cancer Campus (GRCC) Villejuif France
| | - Helene Boutroux
- Department of Pediatric Hematology and Oncology Trousseau Hospital (AP‐HP) Paris France
| | | | | | - Frederic Kolb
- Plastic Surgery Department Institut de Cancérologie Gustave Roussy Cancer Campus (GRCC) Villejuif France
| | - Stephanie Bolle
- Radiation Oncology Department Institut de Cancérologie Gustave Roussy Cancer Campus (GRCC) Villejuif France
| | - Matthieu Carton
- Department of Biostatistics Institut Curie PSL University Paris France
| | | | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer) Institut Curie PSL University Paris France
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14
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Heske CM, Mascarenhas L. Relapsed Rhabdomyosarcoma. J Clin Med 2021; 10:804. [PMID: 33671214 PMCID: PMC7922213 DOI: 10.3390/jcm10040804] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/13/2021] [Indexed: 12/14/2022] Open
Abstract
Relapsed rhabdomyosarcoma (RMS) represents a significant therapeutic challenge. Nearly one-third of patients diagnosed with localized RMS and over two-thirds of patients with metastatic RMS will experience disease recurrence following primary treatment, generally within three years. Clinical features at diagnosis, including primary site, tumor invasiveness, size, stage, and histology impact likelihood of relapse and prognosis post-relapse. Aspects of initial treatment, including extent of surgical resection, use of radiotherapy, and chemotherapy regimen, are also associated with post-relapse outcomes, as are features of the relapse itself, including time to relapse and extent of disease involvement. Although there is no standard treatment for patients with relapsed RMS, several general principles, including tissue biopsy confirmation of diagnosis, assessment of post-relapse prognosis, determination of the feasibility of additional local control measures, and discussion of patient goals, should all be part of the approach to care. Patients with features suggestive of a favorable prognosis, which include those with botryoid RMS or stage 1 or group I embryonal RMS (ERMS) who have had no prior treatment with cyclophosphamide, have the highest chance of achieving long-term cure when treated with a multiagent chemotherapy regimen at relapse. Unfortunately, patients who do not meet these criteria represent the majority and have poor outcomes when treated with such regimens. For this group, strong consideration should be given for enrollment on a clinical trial.
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Affiliation(s)
- Christine M. Heske
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Leo Mascarenhas
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Division of Hematology/Oncology, Department of Pediatrics and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA;
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15
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Affinita MC, Ferrari A, Chiaravalli S, Melchionda F, Quaglietta L, Casanova M, Zanetti I, Scarzello G, Di Pasquale L, Di Cataldo A, Bisogno G. Defining the impact of prognostic factors at the time of relapse for nonmetastatic rhabdomyosarcoma. Pediatr Blood Cancer 2020; 67:e28674. [PMID: 32860661 DOI: 10.1002/pbc.28674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/14/2020] [Accepted: 08/11/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The prognosis for patients with relapsed rhabdomyosarcoma (RMS) depends on a number of variables, including tumor characteristics, type of relapse, and treatment received. All published studies have considered tumor characteristics at initial diagnosis, but not at the time of recurrence. In this study, we compared tumor characteristics at diagnosis and at the moment of local relapse to better define the chance of cure in this group of patients. METHODS We first analyzed 92 children with localized RMS treated according to the RMS96 and RMS2005 protocols who developed relapse after achieving complete remission at the end of treatment. Then we restricted our analysis to 51 patients with local recurrence to compare their initial tumor characteristics with those at relapse. All characteristics were studied using univariate and multivariate analyses. RESULTS The 10-year progression-free survival (PFS) and overall survival (OS) rates for the whole group were 23.5% (15.4-32.6) and 34.4% (24.8-44.1), respectively. On multivariate analysis, only primary tumor site appeared to have a strong impact on prognosis (P = .0010). The 10-year PFS and OS rates of patients with locoregional recurrences were 22.7% (12.3-35.0) and 34.9% (22.1-47.9), respectively. Multivariate analysis showed that tumors at unfavorable sites (P = .0044), and tumor size > 5 cm at recurrence (P = .0088) were associated with the poorest prognosis. CONCLUSION Our study demonstrates that to estimate the chance of cure in patients with relapsed RMS, we should also consider tumor characteristics at the time of relapse, and tumor size in particular.
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Affiliation(s)
- Maria Carmen Affinita
- Oncohematology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Fraia Melchionda
- 'Lalla Seragnoli' Pediatric Oncology and Hematology Unit, S Orsola-Malpighi Hospital, Bologna, Italy
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Ospedale Santobono-Pausilipon, Naples, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ilaria Zanetti
- Oncohematology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Giovanni Scarzello
- Oncohematology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Luisa Di Pasquale
- Pediatric Oncohematology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Di Cataldo
- Pediatric Oncohematology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Gianni Bisogno
- Oncohematology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
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Wen Y, Huang D, Zhang W, Zhang Y, Hu H, Li J. Radiation therapy is an important factor to improve survival in pediatric patients with head and neck rhabdomyosarcoma by enhancing local control: a historical cohort study from a single center. BMC Pediatr 2020; 20:265. [PMID: 32471472 PMCID: PMC7260775 DOI: 10.1186/s12887-020-02165-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study is to analyze the influence of radiation therapy on survival in a historical cohort of 56 pediatric patients with head and neck rhabdomyosarcoma. Methods A historical cohort of 56 pediatric patients with head and neck rhabdomyosarcoma from June 1st, 2013 to June 30th, 2019 was chosen. Clinical data and follow up results were collected including all diagnosis, treatment and prognosis information. Overall survival (OS) and event free survival (EFS) as time-to-event distributions were estimated with Kaplan-Meier method, and univariate analysis was performed with log rank test to detect differences between groups. Multivariate analysis was performed to explore the risk factors for survival with Cox proportional hazard model. Results The media follow up time of all 56 patients was 31.8 months (range 3.5–74.6 months). There were 26 events during follow up, including 14 disease progressions and 12 relapses. The estimated 5-year OS of all patients was 69.9%, and the estimated 5-year EFS was 48.8%. Patients with radiation therapy as a component of the initial treatment plan had better 5-year OS and EFS compared with those without radiation therapy (OS 80.3% vs. 49.7%, p = 0.003 and EFS 63.9% vs. 21.9%, p < 0.001). In patients with events, those who received salvage radiation therapy had better 5-year OS compared with those who didn’t (OS 66.0% vs. 31.2%, p = 0.033). On multivariate analysis, tumor size > 5 cm and non-initial radiation therapy were independent risk factors for OS in all patients, non-initial radiation therapy was an independent risk factor for EFS in all patients, and tumor size > 5 cm was an independent risk factor for OS in patients with events. Conclusions Radiation therapy as a component of initial treatment can improve the OS and EFS in pediatric head and neck rhabdomyosarcoma patients by enhancing local control, and non-initial radiation therapy is an independent risk factor for OS and EFS. Salvage radiation therapy still can improve OS in patients with disease progression and relapse. Tumor size > 5 cm is an independent risk factor for OS in pediatric HNRMS patients with or without disease progression/relapse.
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Affiliation(s)
- Yuan Wen
- Pediatric Department of Beijing Tongren Hospital, Capital Medical University, 100730, 1# Dong Jiao Min Xiang, Dongcheng District, Beijing, China
| | - Dongsheng Huang
- Pediatric Department of Beijing Tongren Hospital, Capital Medical University, 100730, 1# Dong Jiao Min Xiang, Dongcheng District, Beijing, China.
| | - Weiling Zhang
- Pediatric Department of Beijing Tongren Hospital, Capital Medical University, 100730, 1# Dong Jiao Min Xiang, Dongcheng District, Beijing, China
| | - Yi Zhang
- Pediatric Department of Beijing Tongren Hospital, Capital Medical University, 100730, 1# Dong Jiao Min Xiang, Dongcheng District, Beijing, China
| | - Huimin Hu
- Pediatric Department of Beijing Tongren Hospital, Capital Medical University, 100730, 1# Dong Jiao Min Xiang, Dongcheng District, Beijing, China
| | - Jing Li
- Pediatric Department of Beijing Tongren Hospital, Capital Medical University, 100730, 1# Dong Jiao Min Xiang, Dongcheng District, Beijing, China
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17
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Wang Z, Zhang S, Yang H, Zhuang R, Guo X, Tong H, Zhang Y, Lu W, Zhou Y. Efficacy and safety of anlotinib, a multikinase angiogenesis inhibitor, in combination with epirubicin in preclinical models of soft tissue sarcoma. Cancer Med 2020; 9:3344-3352. [PMID: 32181596 PMCID: PMC7221313 DOI: 10.1002/cam4.2941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 01/05/2020] [Accepted: 01/31/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Anlotinib is a novel, orally administered, multitarget receptor tyrosine kinase inhibitor. It functions by inhibiting tumor angiogenesis and proliferative signaling pathways. In this study, we aimed to investigate the efficacy and safety of anlotinib plus epirubicin in a sarcoma patient-derived xenografts (PDX) model. METHODS We firstly established a PDX model using fresh tumor tissues that were surgically removed from a patient diagnosed with malignant fibrous histiocytoma. Thirty-six PDX models were divided into six groups and treated with anlotinib alone (low-dose, 1.5 or high-dose, 3.0 mg/kg/day, oral gavage), or with anlotinib plus epirubicin (3.0 mg/kg/once weekly, i.p.) when the tumors grew to 150-200 mm3 . After 5 weeks of treatment, the mice were sacrificed, and the tumors were measured by weight and processed for IHC and H&E staining. IHC staining was performed to detect CD31, EGFR, MVD, and Ki-67 on paraffin sections. H&E stainings were performed to examine the microcosmic changes that occurred in the tumor tissues and myocardium, respectively. RESULTS After 5 weeks, treatment with anlotinib or epirubicin alone significantly inhibited tumor growth in the sarcoma PDX model compared with the vehicle control. Tumor volume in the high-dose anlotinib group was significantly smaller than the low-dose anlotinib group (P < .001). Combined high-dose anlotinib and epirubicin treatment resulted in the most pronounced tumor inhibition. In the groups treated with the anlotinib-containing regimen, the expression levels of CD31, EGFR, MVD, and Ki-67 were significantly low. The weight in each group had no statistical differences; the same applied to the hepatic function, cardiac function, and toxicity. CONCLUSIONS High-dose anlotinib combined with epirubicin was an effective and safe therapy for STS.
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Affiliation(s)
- Zhi‐Ming Wang
- Department of Medical OncologyZhongshan HospitalFudan UniversityShanghaiChina
- Xiamen BranchZhongshan HospitalFudan UniversityXiamenChina
| | - Shi‐Long Zhang
- Minhang HospitalFudan UniversityShanghaiChina
- Minhang HospitalFudan UniversityInstitute of Fudan‐Minhang Academic Health SystemShanghaiChina
| | - Hua Yang
- Department of General SurgeryShanghai Public Health Clinical CenterZhongshan Hospital (South Branch)Fudan UniversityShanghaiChina
| | - Rong‐Yuan Zhuang
- Department of Medical OncologyZhongshan HospitalFudan UniversityShanghaiChina
| | - Xi Guo
- Department of Medical OncologyZhongshan HospitalFudan UniversityShanghaiChina
| | - Han‐Xing Tong
- Department of General SurgeryShanghai Public Health Clinical CenterZhongshan Hospital (South Branch)Fudan UniversityShanghaiChina
- Department of General SurgeryZhongshan HospitalFudan UniversityShanghaiChina
| | - Yong Zhang
- Department of General SurgeryShanghai Public Health Clinical CenterZhongshan Hospital (South Branch)Fudan UniversityShanghaiChina
- Department of General SurgeryZhongshan HospitalFudan UniversityShanghaiChina
| | - Wei‐Qi Lu
- Department of General SurgeryShanghai Public Health Clinical CenterZhongshan Hospital (South Branch)Fudan UniversityShanghaiChina
- Department of General SurgeryZhongshan HospitalFudan UniversityShanghaiChina
| | - Yu‐Hong Zhou
- Department of Medical OncologyZhongshan HospitalFudan UniversityShanghaiChina
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18
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Inarejos Clemente EJ, Navallas M, Barber Martínez de la Torre I, Suñol M, Munuera Del Cerro J, Torner F, Garraus M, Navarro OM. MRI of Rhabdomyosarcoma and Other Soft-Tissue Sarcomas in Children. Radiographics 2020; 40:791-814. [PMID: 32243230 DOI: 10.1148/rg.2020190119] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Soft-tissue sarcomas in children comprise a heterogeneous group of entities with variable manifestation depending on the age of the patient and the location of the tumor. MRI is the modality of choice for evaluating musculoskeletal soft-tissue tumors and plays a paramount role in both initial diagnosis and assessment of tumor response during and after treatment. Conventional MRI sequences, such as T1- and T2-weighted imaging, offer morphologic information, which is important for localizing the lesion and describing anatomic relationships but not accurate for determining its malignant or benign nature and may be limited in differentiating tumor response from therapy-related changes. Advanced multiparametric MRI offers further functional information that can help with these tasks by using different imaging sequences and biomarkers. The authors present the role of MRI in rhabdomyosarcoma and other soft-tissue sarcomas in children, emphasizing a multiparametric approach with focus on the utility and potential added value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI in characterization and staging, determination of pretreatment extent, and evaluation of tumor response and recurrence after treatment. ©RSNA, 2020.
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Affiliation(s)
- Emilio J Inarejos Clemente
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - María Navallas
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Ignasi Barber Martínez de la Torre
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Mariona Suñol
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Josep Munuera Del Cerro
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Ferran Torner
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Moira Garraus
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Oscar M Navarro
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
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19
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Serial Xenotransplantation in NSG Mice Promotes a Hybrid Epithelial/Mesenchymal Gene Expression Signature and Stemness in Rhabdomyosarcoma Cells. Cancers (Basel) 2020; 12:cancers12010196. [PMID: 31941033 PMCID: PMC7016569 DOI: 10.3390/cancers12010196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/13/2019] [Accepted: 01/09/2020] [Indexed: 02/07/2023] Open
Abstract
Serial xenotransplantation of sorted cancer cells in immunodeficient mice remains the most complex test of cancer stem cell (CSC) phenotype. However, we have demonstrated in various sarcomas that putative CSC surface markers fail to identify CSCs, thereby impeding the isolation of CSCs for subsequent analyses. Here, we utilized serial xenotransplantation of unsorted rhabdomyosarcoma cells in NOD/SCID gamma (NSG) mice as a proof-of-principle platform to investigate the molecular signature of CSCs. Indeed, serial xenotransplantation steadily enriched for rhabdomyosarcoma stem-like cells characterized by enhanced aldehyde dehydrogenase activity and increased colony and sphere formation capacity in vitro. Although the expression of core pluripotency factors (SOX2, OCT4, NANOG) and common CSC markers (CD133, ABCG2, nestin) was maintained over the passages in mice, gene expression profiling revealed gradual changes in several stemness regulators and genes linked with undifferentiated myogenic precursors, e.g., SOX4, PAX3, MIR145, and CDH15. Moreover, we identified the induction of a hybrid epithelial/mesenchymal gene expression signature that was associated with the increase in CSC number. In total, 60 genes related to epithelial or mesenchymal traits were significantly altered upon serial xenotransplantation. In silico survival analysis based on the identified potential stemness-associated genes demonstrated that serial xenotransplantation of unsorted rhabdomyosarcoma cells in NSG mice might be a useful tool for the unbiased enrichment of CSCs and the identification of novel CSC-specific targets. Using this approach, we provide evidence for a recently proposed link between the hybrid epithelial/mesenchymal phenotype and cancer stemness.
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Vaarwerk B, Mallebranche C, Affinita MC, van der Lee JH, Ferrari A, Chisholm JC, Defachelles AS, De Salvo GL, Corradini N, Minard-Colin V, Morosi C, Brisse HJ, McHugh K, Bisogno G, van Rijn RR, Orbach D, Merks JHM. Is surveillance imaging in pediatric patients treated for localized rhabdomyosarcoma useful? The European experience. Cancer 2019; 126:823-831. [PMID: 31750944 PMCID: PMC7027831 DOI: 10.1002/cncr.32603] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/30/2022]
Abstract
Background After the completion of therapy, patients with localized rhabdomyosarcoma (RMS) are subjected to intensive radiological tumor surveillance. However, the clinical benefit of this surveillance is unclear. This study retrospectively analyzed the value of off‐therapy surveillance by comparing the survival of patients in whom relapse was detected by routine imaging (the imaging group) and patients in whom relapse was first suspected by symptoms (the symptom group). Methods This study included patients with relapsed RMS after the completion of therapy for localized RMS who were treated in large pediatric oncology hospitals in France, the United Kingdom, Italy, and the Netherlands and who were enrolled in the International Society of Paediatric Oncology Malignant Mesenchymal Tumor 95 (1995‐2004) study, the Italian Paediatric Soft Tissue Sarcoma Committee Rhabdomyosarcoma 96 (1996‐2004) study, or the European Paediatric Soft Tissue Sarcoma Study Group Rhabdomyosarcoma 2005 (2005‐2013) study. The survival times after relapse were compared with a log‐rank test between patients in the imaging group and patients in the symptom group. Results In total, 199 patients with relapsed RMS were included: 78 patients (39.2%) in the imaging group and 121 patients (60.8%) in the symptom group. The median follow‐up time after relapse was 7.4 years (interquartile range, 3.9‐11.5 years) for survivors (n = 86); the 3‐year postrelapse survival rate was 50% (95% confidence interval [CI], 38%‐61%) for the imaging group and 46% (95% CI, 37%‐55%) for the symptom group (P = .7). Conclusions Although systematic routine imaging is the standard of care after RMS therapy, the majority of relapses were detected as a result of clinical symptoms. This study found no survival advantage for patients whose relapse was detected before the emergence of clinical symptoms. These results show that the value of off‐therapy surveillance is controversial, particularly because repeated imaging may also entail potential harm. This study assesses the clinical value of radiological surveillance imaging in pediatric patients with rhabdomyosarcoma, which is routinely performed after the completion of therapy. In the majority of patients, relapse is detected because of symptoms, and there is no evidence that early detection by imaging results in improved survival.
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Affiliation(s)
- Bas Vaarwerk
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Maria C Affinita
- Hematology and Oncology Division, Department of Woman and Children's Health, Padova University Hospital, Padova, Italy
| | - Johanna H van der Lee
- Pediatric Clinical Research Office, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Andrea Ferrari
- National Cancer Institute of Milan (Scientific Institute for Research, Hospitalization, and Healthcare Foundation), Milan, Italy
| | - Julia C Chisholm
- Children and Young People's Department, Royal Marsden Hospital, Sutton, United Kingdom
| | | | - Gian Luca De Salvo
- Clinical Research Unit, Veneto Institute of Oncology (Scientific Institute for Research, Hospitalization, and Healthcare), Padova, Italy
| | - Nadège Corradini
- Institute of Pediatric Hematology and Oncology, Léon Bérard Center, Lyon, France
| | - Veronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy Institute, Villejuif, France
| | - Carlo Morosi
- National Cancer Institute of Milan (Scientific Institute for Research, Hospitalization, and Healthcare Foundation), Milan, Italy
| | - Hervé J Brisse
- SIREDO Oncology Center, PSL Research University, Curie Institute, Paris, France.,Imaging Department, Curie Institute, Paris, France
| | - Kieran McHugh
- Department of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Gianni Bisogno
- Hematology and Oncology Division, Department of Woman and Children's Health, Padova University Hospital, Padova, Italy
| | - Rick R van Rijn
- Department of Radiology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Daniel Orbach
- SIREDO Oncology Center, PSL Research University, Curie Institute, Paris, France
| | - Johannes H M Merks
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
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21
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Abstract
Rhabdomyosarcoma is the most common soft tissue sarcoma that typically occurs in children and adolescents and is rare in adults. Furthermore, as cardiac tumor is rare, adult cardiac rhabdomyosarcoma is a very rare entity. Here, we report the case of a 68-year-old woman with cardiac rhabdomyosarcoma who was successfully treated with eribulin. She presented with sudden loss of consciousness, which was attributed to the cardiac tumor. The tumor was resected by emergency surgery and was diagnosed as embryonal rhabdomyosarcoma. Although surgical treatment alleviated her symptoms, the residual tumor increased in size after surgery and required multimodal treatment. First-line chemotherapy with the vincristine, actinomycin D, and cyclophosphamide regimen had to be discontinued owing to adverse events, and thus eribulin was used as a second-line treatment. Eribulin was better tolerated and helped maintain a stable disease status for >18 months. This reported case of cardiac rhabdomyosarcoma is the first case to be successfully treated with eribulin over a relatively long period. Eribulin therapy may thus be a viable treatment alternative for rhabdomyosarcoma.
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22
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Feijen EAM, Leisenring WM, Stratton KL, Ness KK, van der Pal HJH, van Dalen EC, Armstrong GT, Aune GJ, Green DM, Hudson MM, Loonen J, Oeffinger KC, Robison LL, Yasui Y, Kremer LCM, Chow EJ. Derivation of Anthracycline and Anthraquinone Equivalence Ratios to Doxorubicin for Late-Onset Cardiotoxicity. JAMA Oncol 2019; 5:864-871. [PMID: 30703192 PMCID: PMC6490232 DOI: 10.1001/jamaoncol.2018.6634] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Anthracyclines are part of many effective pediatric cancer treatment protocols. Most pediatric oncology treatment groups assume that the hematologic toxicity of anthracycline agents is equivalent to their cardiotoxicity; for example, Children's Oncology Group substitution rules consider daunorubicin and epirubicin isoequivalent to doxorubicin, whereas mitoxantrone and idarubicin are considered 4 to 5 times as toxic as doxorubicin. OBJECTIVE To determine optimal dose equivalence ratios for late-onset cardiomyopathy between doxorubicin and other anthracyclines or the anthraquinone mitoxantrone. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study of childhood cancer survivors who survived 5 or more years analyzed data pooled from 20 367 participants in the Childhood Cancer Survivor Study treated from 1970 to 1999, 5741 participants in the Dutch Childhood Oncology Group LATER study diagnosed between 1963 and 2001, and 2315 participants in the St Jude Lifetime study treated from 1962 to 2005. EXPOSURES Cumulative doses of each agent (the anthracyclines doxorubicin, daunorubicin, epirubicin, and idarubicin; and the anthraquinone mitoxantrone) along with chest radiotherapy exposure were abstracted from medical records. MAIN OUTCOMES AND MEASURES Cardiomyopathy (severe, life-threatening, or fatal) by 40 years of age. Agent-specific Cox proportional hazards models evaluated cardiomyopathy risk, adjusting for chest radiotherapy, age at cancer diagnosis, sex, and exposure to anthracyclines or to an anthraquinone. An agent-specific cardiomyopathy equivalence ratio (relative to doxorubicin) was estimated for each dose category as a ratio of the hazard ratios, and then a weighted mean determined the overall agent-specific equivalence ratio across all dose categories. RESULTS Of 28 423 survivors (46.4% female; median age at cancer diagnosis 6.1 years [range, 0.0-22.7 years]), 9330 patients received doxorubicin, 4433 received daunorubicin, 342 received epirubicin, 241 received idarubicin, and 265 received mitoxantrone. After a median follow-up of 20.0 years (range, 5.0-40.0 years) following receipt of a cancer diagnosis, 399 cardiomyopathy cases were observed. Relative to doxorubicin, the equivalence ratios were 0.6 (95% CI, 0.4-1.0) for daunorubicin, 0.8 (95% CI, 0.5-2.8) for epirubicin, and 10.5 (95% CI, 6.2-19.1) for mitoxantrone. Outcomes were too rare to generate idarubicin-specific estimates. Ratios based on a continuous linear dose-response relationship were similar for daunorubicin (0.5 [95% CI, 0.4-0.7]) and epirubicin (0.8 [95% CI, 0.3-1.4]). The relationship between mitoxantrone and doxorubicin appeared better characterized by a linear exponential model. CONCLUSIONS AND RELEVANCE In a large data set assembled to examine long-term cardiomyopathy risk in childhood cancer survivors, daunorubicin was associated with decreased cardiomyopathy risk vs doxorubicin, whereas epirubicin was approximately isoequivalent. By contrast, the current hematologic-based doxorubicin dose equivalency of mitoxantrone (4:1) appeared to significantly underestimate the association of mitoxantrone with long-term cardiomyopathy risk.
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Affiliation(s)
- Elizabeth A. M. Feijen
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Wendy M. Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kayla L. Stratton
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Elvira C. van Dalen
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory J. Aune
- Department of Pediatrics, Greehey Children’s Cancer Research Institute, The University of Texas Health Science Center at San Antonio
| | - Daniel M. Green
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kevin C. Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Leontien C. M. Kremer
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Eric J. Chow
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle
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23
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Sparber-Sauer M, Stegmaier S, Vokuhl C, Seitz G, von Kalle T, Scheer M, Münter M, Bielack SS, Weclawek-Tompol J, Ladenstein R, Niggli F, Ljungman G, Fuchs J, Hettmer S, Koscielniak E, Klingebiel T. Rhabdomyosarcoma diagnosed in the first year of life: Localized, metastatic, and relapsed disease. Outcome data from five trials and one registry of the Cooperative Weichteilsarkom Studiengruppe (CWS). Pediatr Blood Cancer 2019; 66:e27652. [PMID: 30762282 DOI: 10.1002/pbc.27652] [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: 11/07/2018] [Revised: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) diagnosed during the first year of life is reported to have poor outcome. Little is known about treatment and outcome data of relapsed disease (RD). METHODS Characteristics, treatment, and outcome of 155 patients ≤ 12 months registered within the Cooperative Weichteilsarkom Studiengruppe (CWS) between 1981 and 2016 were evaluated. RESULTS Localized disease (LD) was diagnosed in 144 patients and metastatic disease (MD) in 11. The histological diagnosis was alveolar (RMA) (n = 38, 23/25 examined patients PAX7/3:FOXO1-positive), embryonal (RME) (n = 100), botryoid (n = 10), anaplastic (n = 1), and spindle-cell RMS (n = 6). Multimodal treatment including conventional (age-adjusted) chemotherapy (CHT) (n = 150), resection (n = 137), and radiotherapy (RT) (n = 37) was administered. Complete remission was achieved in 129 of 144 patients with LD. RD occurred in 51 infants at a median age of 1.7 years (range, 0.3-8.8). Sixty-three percent of patients with RMA suffered RD, in contrast to 28% of patients with RME. Relapse treatment consisted of conventional CHT (n = 48), resection (n = 28), and RT (n = 21). The pattern of relapse and best resection were significant prognostic factors for patients with RD (P = 0.000 and P = 0.002). Late effects occurred as secondary malignancies in 6%, long-term toxicity in 21%, and resection-related impairment in 33% of the 105 surviving patients. The 5-year event-free survival and overall survival for infants with initial LD were 51% and 69%, 14% and 14% for patients with initial MD and 39% and 41% for relapsed patients, respectively. CONCLUSION Multimodal treatment including microscopically complete resection is strongly recommended to achieve a good prognosis in LD and RD of infants with RMS.
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Affiliation(s)
- Monika Sparber-Sauer
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Sabine Stegmaier
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Christian Vokuhl
- Section of Pediatric Pathology, Department of Pathology, Kiel Pediatric Tumor Registry, Kiel, Germany
| | - Guido Seitz
- Department of Pediatric Surgery, University Children's Hospital Marburg, Marburg, Germany
| | - Thekla von Kalle
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Olgahospital, Institute of Radiology, Stuttgart, Germany
| | - Monika Scheer
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Marc Münter
- Klinikum Stuttgart, Institute of Radiotherapy, Stuttgart, Germany
| | - Stefan S Bielack
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany.,Department of Pediatric Hematology and Oncology, University of Muenster, Muenster, Germany
| | | | | | - Felix Niggli
- Department of Pediatric Oncology, University of Zurich, Zurich, Switzerland
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Children's University Hospital, University of Uppsala, Uppsala, Sweden
| | - Joerg Fuchs
- Department of Pediatric Surgery and Urology, University Children's Hospital, Tuebingen, Germany
| | - Simone Hettmer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ewa Koscielniak
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany.,Department of Pediatric Hematology and Oncology, Children's Hospital, Tuebingen, Germany
| | - Thomas Klingebiel
- Department for Children and Adolescents, University Hospital of Frankfurt, Frankfurt/M., Germany
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24
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Xu N, Hua Z, Ba G, Zhang S, Liu Z, Thiele CJ, Li Z. The anti-tumor growth effect of a novel agent DMAMCL in rhabdomyosarcoma in vitro and in vivo. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2019; 38:118. [PMID: 30850026 PMCID: PMC6408795 DOI: 10.1186/s13046-019-1107-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 02/14/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children with poor survival. New treatment approaches are urgently needed to improve treatment efficacy in RMS patients. DMAMCL is a novel agent from Asteraceae family that has been tested in phase I clinical trials in adult glioma in Australia. METHODS Five RMS cell lines (RD, RH18, RH28, RH30 and RH41) were used. The in vitro anti-tumor effect of DMAMCL, alone or in combination with VCR or Epirubicin, was studied using MTS assay or IncuCyte-Zoom cell confluency assay, and further validated by xenograft-mouse model in vivo. Changes in caspase-3/7 activity, cell-cycle progression and generation of ROS after DMAMCL treatment were investigated. Bim mRNA expression was measured by RT-qPCR, and protein expressions of Bim and phosphorylated-NF-κB(p65) by Western blotting. Small interfering RNAs (siRNA) of Bim were used to study the role of Bim in DMAMCL-induced cell death. RESULTS In vitro, DMAMCL treatment induced a dose-dependent increase in cell death that could be blocked by pan-caspase-inhibitor-Z-VAD-fmk in five RMS cell lines. The percent of cells in SubG1 phase and activities of caspase-3/7 increased after DMAMCL treatment; The combination of DMAMCL with VCR or Epirubicin significantly increased cell death compared to each reagent alone. In vivo, DMAMCL(75 mg/kg or 100 mg/kg) inhibited tumor growth and prolonged survival of mice bearing xenograft RMS tumors (RD, RH18, RH30, RH41). Compared to treatment with DMAMCL or VCR, a combination of two reagents caused significant inhibition of tumor growth (RD, RH41), even after treatment termination. The expression of Bim increased at protein level after DMAMCL treatment both in vitro and in vivo. The expression of p-NF-κB(p65) had a transient increase and the generation of ROS increased after DMAMCL treatment in vitro. Transfection of Bim siRNA into RMS cells blocked the DMAMCL-induced increase of Bim and partially attenuated the DMAMCL-induced cell death. CONCLUSION DMAMCL had an anti-tumor growth effect in vitro and in vivo that potentially mediated by Bim, NF-κB pathway and ROS. A combination of DMAMCL with chemotherapeutic drugs significantly increased the treatment efficacy. Our study supports further clinical evaluation of DMAMCL in combination with conventional chemotherapy.
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Affiliation(s)
- Ning Xu
- Liaoning Key Laboratory of Research and Application of Animal Models for Environmental and Metabolic Diseases, Medical Research Center, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Zhongyan Hua
- Liaoning Key Laboratory of Research and Application of Animal Models for Environmental and Metabolic Diseases, Medical Research Center, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Gen Ba
- Liaoning Key Laboratory of Research and Application of Animal Models for Environmental and Metabolic Diseases, Medical Research Center, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Simeng Zhang
- Liaoning Key Laboratory of Research and Application of Animal Models for Environmental and Metabolic Diseases, Medical Research Center, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Zhihui Liu
- Cellular & Molecular Biology Section, Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Carol J Thiele
- Cellular & Molecular Biology Section, Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Zhijie Li
- Liaoning Key Laboratory of Research and Application of Animal Models for Environmental and Metabolic Diseases, Medical Research Center, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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25
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Cho HW, Lee JW, Ma Y, Yoo KH, Sung KW, Koo HH. Treatment Outcomes in Children and Adolescents with Relapsed or Progressed Solid Tumors: a 20-year, Single-Center Study. J Korean Med Sci 2018; 33:e260. [PMID: 30288158 PMCID: PMC6170668 DOI: 10.3346/jkms.2018.33.e260] [Citation(s) in RCA: 9] [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] [Received: 02/20/2018] [Accepted: 06/20/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND By estimating the survival rates and exploring prognostic factors in pediatric patients with relapsed or progressed solid tumors, our purpose was to generate background data for future studies. METHODS We reviewed the medical records of 258 patients with solid tumors who experienced relapse/progression and received subsequent salvage treatment between 1996 and 2016. RESULTS A total of 60 patients remained progression-free during first-line salvage treatment, while the remaining 198 patients experienced relapse/progression again; 149 underwent second-line salvage treatment. A total of 76 patients underwent high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT), and 44 patients received allogeneic SCT. The 10-year progression-free survival (PFS) and overall survival (OS) from relapse/progression were 18.4% ± 2.7% and 24.5% ± 3.0%, respectively. Survival rates were relatively higher in patients with anaplastic ependymoma, initially non-high-risk neuroblastoma, osteosarcoma, Wilms tumor and retinoblastoma. A multivariate analysis showed that relapse/progression during initial treatment, metastatic relapse/progression, and impossible debulking surgery were independent poor prognostic factors for both PFS and OS. Patients who exhibited a complete response or partial response during conventional salvage treatment showed significantly higher survival after SCT than those with stable disease or progressive disease (10-year OS: 54.8% ± 7.0% vs. 7.0% ± 3.5%, P < 0.001). CONCLUSION The prognosis of relapsed/progressed pediatric solid tumors still remains unsatisfactory. New, effective treatment strategies are needed to overcome limitations of current approaches. Hopefully, the background data generated herein will be used in future clinical trials involving patients with relapsed/progressed solid tumors.
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Affiliation(s)
- Hee Won Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youngeun Ma
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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26
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Compostella A, Affinita MC, Casanova M, Milano GM, Scagnellato A, Dall'Igna P, Chiaravalli S, Pierobon M, Manzitti C, Zanetti I, Schiavetti A, Sorbara S, Mura RM, Ruggiero A, Ferrari A, Bisogno G. Topotecan/carboplatin regimen for refractory/recurrent rhabdomyosarcoma in children: Report from the AIEOP Soft Tissue Sarcoma Committee. TUMORI JOURNAL 2018; 105:138-143. [PMID: 30131003 DOI: 10.1177/0300891618792479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION From 2002 to 2011, the Italian Soft Tissue Sarcoma Committee explored a combination of topotecan and carboplatin as a second-line strategy for children with resistant or relapsing rhabdomyosarcoma. METHODS Patients received two blocks of topotecan 2 mg/m2 on days 1, 2, and 3, and carboplatin 250 mg/m2 on days 4 and 5, followed by alternating blocks of topotecan-cyclophosphamide and carboplatin-etoposide for a total of six courses with 3-week intervals. Tumor response was assessed after two cycles, and local control was implemented when feasible. RESULTS A total of 38 patients were included in this study: 18/38 had alveolar rhabdomyosarcoma (RMS), 10/38 had metastatic disease at diagnosis, 8/38 had tumor progression during first-line chemotherapy, 21/38 had locoregional relapses, and 9/38 had distant relapses. Thirty-two patients could be assessed for tumor response to topotecan-carboplatin, and 9 (28%) showed a complete or partial response. Twenty-four patients experienced grade IV hematologic toxicity, while transient grade 1 tubulopathy, grade 3 mucositis, transient grade 2 nephrotoxicity, and a grade 2 decline in cardiac function occurred in one patient each. The 5-year overall and progression-free survival rates were 17% and 14%, respectively. CONCLUSION the prognosis for children with resistant or relapsing RMS remains unsatisfactory. The topotecan-carboplatin regimen was well-tolerated. Though in case of late relapse the response rate was similar to those reported for other regimes, the result achieved remains unsatisfactory. New approaches, possibly including target agents, seem more attractive for future studies.
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Affiliation(s)
- Alessia Compostella
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Maria Carmen Affinita
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Michela Casanova
- 2 Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | | | - Angela Scagnellato
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | | | - Stefano Chiaravalli
- 2 Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Marta Pierobon
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Carla Manzitti
- 5 Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Ilaria Zanetti
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Amalia Schiavetti
- 6 Pediatric Oncology Unit, Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Silvia Sorbara
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Rosella Maria Mura
- 7 Pediatric Hematology-Oncology, Ospedale Pediatrico Microcitemico, Cagliari, Italy
| | - Antonio Ruggiero
- 8 Pediatric Oncology Division, Catholic University of Rome, Rome, Italy
| | - Andrea Ferrari
- 2 Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Gianni Bisogno
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
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27
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Büyükkapu Bay S, Kebudi R, Görgün O, Zülfikar B, Darendeliler E, Çakır FB. Vincristine, irinotecan, and temozolomide treatment for refractory/relapsed pediatric solid tumors: A single center experience. J Oncol Pharm Pract 2018; 25:1343-1348. [PMID: 30080131 DOI: 10.1177/1078155218790798] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although the survival of pediatric cancer has increased dramatically in the last decades, the survival of refractory, relapsed, and metastatic cases is still dismal. The combination of irinotecan and temozolomide has shown activity against refractory/relapsed pediatric solid tumors. METHOD Thirty-four children with refractory/relapsed solid tumors who had previously been heavily pretreated and who were given vincristine, irinotecan, and temozolomide as third- or further line chemotherapy during 2004-2015 were evaluated. RESULTS Patients were diagnosed with Ewing sarcoma (n = 15), rhabdomyosarcoma (n = 8), neuroblastoma (n = 8), osteosarcoma (n = 2), and Wilms' tumor (n = 1). Thirty patients presented with disease progression on therapy and the other four presented with relapsing. A total of 141 cycles were administered. Radiotherapy was used in 17 patients and surgery in 4 as local therapy. Among all patients, 6 had complete response, 3 had partial response, 14 had stable disease, and 11 had progressive disease. The objective response was 26.4% (complete response + partial response) and median survival duration was six months. The first and second year overall survival rates were 22.3% and 16.8%. The objective response in Ewing sarcoma patients was 40%. Diarrhea was the most common toxicity and 14 (10%) courses were associated with grade 3-4 diarrhea. CONCLUSIONS In heavily pretreated patients with refractory/relapsed solid tumors, the vincristine, irinotecan, and temozolomide regimen seemed promising in Ewing sarcoma patients and was well tolerated.
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Affiliation(s)
- Sema Büyükkapu Bay
- 1 Division of Pediatric Hematology-Oncology, Istanbul University, Institute of Oncology, Istanbul, Turkey
| | - Rejin Kebudi
- 2 Division of Pediatric Hematology-Oncology, Istanbul University, Cerrahpasa Medical Faculty & Istanbul University Oncology Institute, Istanbul, Turkey
| | - Omer Görgün
- 2 Division of Pediatric Hematology-Oncology, Istanbul University, Cerrahpasa Medical Faculty & Istanbul University Oncology Institute, Istanbul, Turkey
| | - Bülent Zülfikar
- 2 Division of Pediatric Hematology-Oncology, Istanbul University, Cerrahpasa Medical Faculty & Istanbul University Oncology Institute, Istanbul, Turkey
| | - Emin Darendeliler
- 3 Department of Radiation Oncology, Istanbul University, Institute of Oncology, Istanbul, Turkey
| | - Fatma B Çakır
- 4 Division of Pediatric Hematology-Oncology, Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
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Abstract
PURPOSE OF REVIEW Three primary categories of gynecologic cancer are found in pediatric and adolescent patients: stromal carcinomas including juvenile granulosa cell tumors and Sertoli-Leydig cell tumors, rhabdomyosarcomas arising from the vagina and cervix (sarcoma botryoides), and ovarian germ cell tumors which comprise a wide range of histologies. These entities are rare and treatment approaches have focused on decreasing late effects of chemotherapy treatment. Here, we review presentation, histologic classifications, diagnosis, and treatment recommendations for pediatric gynecologic cancers. RECENT FINDINGS Event-free and overall survival for these cancers is high, and the goals of treatment are minimization of morbidity and preservation of fertility with unilateral salpingo-oophorectomies and limited staging. Surveillance of tumor markers after surgery is helpful in monitoring for disease progression and adjuvant chemotherapy is often reserved for patients at recurrence. Recent literature supports avoiding chemotherapy even in high-grade germ cell tumors in the pediatric population.
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Borinstein SC, Steppan D, Hayashi M, Loeb DM, Isakoff MS, Binitie O, Brohl AS, Bridge JA, Stavas M, Shinohara ET, Meyer WH, Reed DR, Wagner LM. Consensus and controversies regarding the treatment of rhabdomyosarcoma. Pediatr Blood Cancer 2018; 65. [PMID: 28905489 DOI: 10.1002/pbc.26809] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/28/2017] [Accepted: 08/10/2017] [Indexed: 12/20/2022]
Abstract
Optimal treatment of rhabdomyosarcoma (RMS) requires multidisciplinary approach, incorporating chemotherapy with local control. Although current therapies are built on cooperative group trials, a comprehensive standard of care to guide clinical decision making has been lacking, especially for relapsed patients. Therefore, we assembled a panel of pediatric and adolescent and young adult sarcoma experts to develop treatment guidelines for managing RMS and to identify areas in which further research is needed. We created algorithms incorporating evidence-based care for patients with RMS, emphasizing the importance of clinical trials and close integration of all specialties involved in the care of these patients.
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Affiliation(s)
- Scott C Borinstein
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Diana Steppan
- Division of Pediatric Oncology, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Masanori Hayashi
- Division of Pediatric Oncology, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - David M Loeb
- Division of Pediatric Oncology, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Michael S Isakoff
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Odion Binitie
- Sarcoma Department, Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Andrew S Brohl
- Sarcoma Department, Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Julia A Bridge
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark Stavas
- Division of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric T Shinohara
- Division of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William H Meyer
- Jimmy Everest Section of Pediatric Hematology/Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Damon R Reed
- Sarcoma Department, Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Lars M Wagner
- Division of Pediatric Hematology/Oncology, University of Kentucky, Lexington, Kentucky
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30
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Setty BA, Stanek JR, Mascarenhas L, Miller A, Bagatell R, Okcu F, Nicholls L, Lysecki D, Gupta AA. VIncristine, irinotecan, and temozolomide in children and adolescents with relapsed rhabdomyosarcoma. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26728. [PMID: 28748602 PMCID: PMC7497851 DOI: 10.1002/pbc.26728] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/06/2017] [Accepted: 06/20/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND The combination of vincristine, irinotecan, and temozolomide (VIT) is often used to treat children and adolescents with relapsed rhabdomyosarcoma (RMS); however, the outcome of these patients has not been previously described. PROCEDURES We sought to determine the response rate (RR) and progression-free survival (PFS) for patients with relapsed RMS treated with VIT by retrospective review of patients treated at five tertiary care hospitals. Prior treatment with irinotecan was permitted. RESULTS Among 19 patients with a median age of 8 years (range 2-17 years), 12 (63%) were males and 12 (63%) had embryonal histology. Median time to relapse from initial diagnosis was 16 months (range 2.8-45 months). VIT was used as first, second, third, or fourth line of therapy in four (21%), seven (37%), six (32%), and two (10%) patients, respectively. Four patients received VIT as adjuvant therapy following radiation and/or surgery. Therefore, among 15 evaluable patients, the best response to VIT was 0 (complete response, CR), 0 (partial response, PR), 4 (stable disease, SD), and 11 (progressive disease, PD) for an overall clinical benefit rate (CR + PR + SD) of 26.7% (95% CI: 7.8-55.1%). After a median follow-up of 8 months, 2 (10%) patients were alive without disease, 3 (16%) were alive with disease, and 14 (74%) patients died of PD. PFS at 3 months was 23% (95% CI: 5.7-46.7%). CONCLUSIONS VIT therapy in combination with adequate local control is associated with some disease control in patients with first relapse RMS and may be another reasonable option to offer patients as salvage therapy.
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Affiliation(s)
- Bhuvana A Setty
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph R Stanek
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Leo Mascarenhas
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Alexandra Miller
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rochelle Bagatell
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fatih Okcu
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lauren Nicholls
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Lysecki
- Division of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Abha A Gupta
- Department of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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31
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Igarashi K, Murakami T, Kawaguchi K, Kiyuna T, Miyake K, Zhang Y, Nelson SD, Dry SM, Li Y, Yanagawa J, Russell TA, Singh AS, Tsuchiya H, Elliott I, Eilber FC, Hoffman RM. A patient-derived orthotopic xenograft (PDOX) mouse model of a cisplatinum-resistant osteosarcoma lung metastasis that was sensitive to temozolomide and trabectedin: implications for precision oncology. Oncotarget 2017; 8:62111-62119. [PMID: 28977930 PMCID: PMC5617490 DOI: 10.18632/oncotarget.19095] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/24/2017] [Indexed: 01/08/2023] Open
Abstract
In the present study, we evaluated the efficacy of trabectedin (TRAB) and temozolomide (TEM) compared to cisplatinum (CDDP) on a patient-derived orthotopic xenogrraft (PDOX) of a lung-metastasis from an osteosarcoma of a patient who failed CDDP therapy. Osteosarcoma resected from the patient was implanted orthotopically in the distal femur of mice to establish PDOX models which were randomized into the following groups when tumor volume reached approximately 100 mm3: G1, control without treatment; G2, CDDP (6 mg/kg, intraperitoneal injection, weekly, for 2 weeks); G3, TRAB (0.15 mg/kg, intravenous injection, weekly, for 2 weeks); G4, TEM (25 mg/kg, oral, daily, for 14 days). Tumor size and body weight were measured with calipers and a digital balance, respectively, twice a week. On day 14 after initiation of treatment, TEM and TRAB, but not CDDP, significantly inhibited tumor volume compared to untreated control: control (G1): 814.5±258.8 mm3; CDDP (G2): 608.6±126.9 mm3; TRAB (G3): 286.6±133.0 mm3; TEM (G4): 182.9±69.1 mm3. CDDP vs. control, p=0.07; TRAB vs. control, p=0.0004; TEM vs. control p =0.0002; TRAB vs. CDDP, p =0.0002; TEM vs. CDDP, p =0.00003. The results of the present study show that a PDOX model of an osteosarcoma lung-metastasis that recurred after adjuvant CDDP-treatment has identified potentially, highly-effective drugs for this recalcitrant disease, while accurately maintaining the CDDP resistance of the tumor in the patient, thereby demonstrating the potential of the osteosarcoma PDOX model for precision oncology.
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Affiliation(s)
- Kentaro Igarashi
- AntiCancer, Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA.,Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Takashi Murakami
- AntiCancer, Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA
| | - Kei Kawaguchi
- AntiCancer, Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA
| | - Tasuku Kiyuna
- AntiCancer, Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA
| | - Kentaro Miyake
- AntiCancer, Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA
| | - Yong Zhang
- AntiCancer, Inc., San Diego, California, USA
| | - Scott D Nelson
- Department of Pathology, University of California, Los Angeles, California, USA
| | - Sarah M Dry
- Department of Pathology, University of California, Los Angeles, California, USA
| | - Yunfeng Li
- Department of Pathology, University of California, Los Angeles, California, USA
| | - Jane Yanagawa
- Division of Surgical Oncology, University of California, Los Angeles, California, USA
| | - Tara A Russell
- Division of Surgical Oncology, University of California, Los Angeles, California, USA
| | - Arun S Singh
- Division of Hematology-Oncology, University of California, Los Angeles, California, USA
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Irmina Elliott
- Division of Surgical Oncology, University of California, Los Angeles, California, USA
| | - Fritz C Eilber
- Division of Surgical Oncology, University of California, Los Angeles, California, USA
| | - Robert M Hoffman
- AntiCancer, Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA
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32
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Mallebranche C, Carton M, Minard-Colin V, Desfachelle AS, Rome A, Brisse HJ, Mosseri V, Thébaud E, Pellier I, Boutroux H, Gandemer V, Corradini N, Orbach D. [Relapse after rhabdomyosarcoma in childhood and adolescence: Impact of an early detection on survival]. Bull Cancer 2017; 104:625-635. [PMID: 28687117 DOI: 10.1016/j.bulcan.2017.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 12/21/2022]
Abstract
SUBJECT Prognostic values of an early detection of a relapse after treatment of a localized rhabdomyosarcoma and the interest of performing systematic radiologic assessment after treatment have not yet been evaluated in Europe. MATERIAL AND METHODS Modalities of relapse of 99 patients under 20 years of age, after an initially localized rhabdomyosarcoma, treated in 9 French centers ("Société française des cancers de l'enfant" consortium) have been analyzed. Prognostic value of the protocol compliance during the observation period after therapy has been evaluated. RESULTS Relapses have been diagnosed in 59 cases by a "symptom" the child was complaining of, in 12 cases because of "physical signs" detected during the clinical examination of a systematic consultation and in 27 cases thanks to "systematic follow-up imaging" (missing data: 1 case). Survival after relapse at 3 years was 47.5 % (IC95 %: 37.1 %-57.1 %). Diagnosis of the relapse is established earlier in the group "systematic imaging" rather than with other methods of detection ("symptom", "physical signs"), (P= 0.025), with detection of smaller tumors (≤ 5 cm ; 100.0 % vs. 60.9 % vs. 77.8 %, P= 0.007) but without possibility of reaching a second remission (70.4 % vs. 50.8 % vs. 50.0 % P= 0.37), nor significant impact on 5-year overall survival (47.1 % vs. 47.1 % vs. 48.6 % P= 0.94). CONCLUSION Current methods of systematic surveillance after a first-line treatment of an initially localized rhabdomyosarcoma seem to improve the earliness of the diagnosis, but not the prognosis of the relapse.
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Affiliation(s)
- Coralie Mallebranche
- Centre oncologie SIREDO (soins, innovation, recherche autour des tumeurs de l'enfant, l'adolescent et le jeune adulte), institut Curie, 26, rue d'Ulm, 75005 Paris, France; CHU d'Angers, service d'immuno-hémato-oncologie pédiatrique, 4, rue Larrey, 49100 Angers, France.
| | - Matthieu Carton
- DCRI-ensemble hospitalier, institut Curie, unité de biométrie, 26, rue d'Ulm, 75005 Paris, France
| | - Véronique Minard-Colin
- Gustave-Roussy, département de cancérologie de l'enfant et l'adolescent, 114, rue Edouard-Vaillant, 94805 Villejuif cedex, France
| | - Anne-Sophie Desfachelle
- Centre Oscar-Lambret, unité d'oncologie pédiatrique, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Angélique Rome
- CHU de Marseille, hôpital de la Timone, service d'oncologie pédiatrique, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Hervé J Brisse
- Institut Curie, département de radiologie, 26, rue d'Ulm, 75005 Paris, France
| | - Véronique Mosseri
- DCRI-ensemble hospitalier, institut Curie, unité de biométrie, 26, rue d'Ulm, 75005 Paris, France
| | - Estelle Thébaud
- CHU de Nantes, service d'hématologie et d'oncologie pédiatrique, 8, quai Moncousu, 44000 Nantes, France
| | - Isabelle Pellier
- CHU d'Angers, service d'immuno-hémato-oncologie pédiatrique, 4, rue Larrey, 49100 Angers, France
| | - Hélène Boutroux
- APHP, hôpital Armand-Trousseau, service d'hémato-oncologie pédiatrique, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Virginie Gandemer
- CHU de Rennes, hôpital Sud, service d'hématologie et oncologie pédiatrique, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - Nadège Corradini
- Institut d'hématologie et oncologie pédiatrique, 1, place Professeur-Joseph-Renaut, 69008 Lyon, France
| | - Daniel Orbach
- Centre oncologie SIREDO (soins, innovation, recherche autour des tumeurs de l'enfant, l'adolescent et le jeune adulte), institut Curie, 26, rue d'Ulm, 75005 Paris, France
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33
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Sertoli-Leydig Cell Tumor with Concurrent Rhabdomyosarcoma: Three Case Reports and a Review of the Literature. Case Rep Med 2017; 2017:4587296. [PMID: 28751916 PMCID: PMC5511678 DOI: 10.1155/2017/4587296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/19/2017] [Accepted: 05/29/2017] [Indexed: 12/24/2022] Open
Abstract
Sertoli-Leydig Cell Tumors (SLCTs) make up <1% of all ovarian tumors and are benign or malignant, androgen-secreting tumors. Rhabdomyosarcoma (RMS) is a heterogeneous group of malignant tumors that resemble developing skeletal muscle. There have been case reports of patients with concurrent SLCT and RMS with limited treatment options. We aim to demonstrate treatment strategies used in our patients, which seemed to have prolonged survival when compared to prior case reports of patients not cured by surgical resection. Herein we describe 22 cases of SLCT with RMS elements as discussed in prior case reports and three cases from the authors' institution. Of the 19 cases from prior case reports, five were lost to follow-up and two had NED after surgical intervention. Eleven patients had recurrence and were deceased within one year. Of those patients not surgically cured, only three patients were documented as living beyond two years, all of whom received chemotherapy. The three patients presented from our institution had clinical evidence of response to chemotherapy that is traditionally used for RMS. In conclusion, chemotherapy with doxorubicin and ifosfamide has activity in patients with SLCT and RMS as does salvage chemotherapy with vincristine, irinotecan, and temozolomide.
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34
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Abstract
Since its foundation by remarkably talented and insightful individuals, prominently including Pepper Dehner, pediatric soft tissue tumor pathology has developed at an immense rate. The morphologic classification of tumoral entities has extensively been corroborated, but has also evolved with refinement or realignment of these classifications, through accruing molecular data, with many derivative ancillary diagnostic assays now already well-established. Tumors of unclear histogenesis, classically morphologically undifferentiated, are prominent amongst pediatric sarcomas, however, the classes of undifferentiated round- or spindle-cell-tumors-not-otherwise-specified are being dismantled gradually with the identification of their molecular underpinnings. Within recent years, for example, numerous subcategories of 'Ewing-like' round cell sarcoma have emerged. Such advances have provided the basis for novel diagnostic and prognostic sub-classifications. Efforts at defining cell- or lineage-of-origin for several tumor types have produced interesting insights especially for rhabdomyosarcoma. The remarkably early onset of pediatric sarcomas defies the theory necessitating stochastic accumulation of several somatic mutations for cancer development and indeed, these tumors may be remarkably genomically stable, often belying their aggressive nature. Much is coming to light recently regarding the role of epigenetic modifications in the evolution of these sarcomas. Indeed the morphologic features of embryonal tumors generally (not just sarcomas) may be highly reminiscent of arrested differentiation, and given the tight epigenetic regulation of cell fate determination and cell identity maintenance, a theory of epigenetically-driven oncogenesis sits easily with these tumors. The age-delimited distinct biologies of 'pediatric' and adult GIST are intriguing, particularly, the SDH-deficient 'pediatric' form, driven by a metabolic defect, but resulting in epigenetic dysregulation with genome-wide DNA methylation changes. There is little doubt that many of the gaps in our understanding of pediatric sarcoma biology will be filled by a deeper appreciation of the role of dysregulated epigenetics including chromatin biology, perhaps best exemplified in malignant rhabdoid tumor. The field of pediatric soft tissue tumor pathology grows ever more interesting. Importantly though, it must be emphasized, that none of this progress could have occurred, or indeed continue, without the initial step of accurate diagnosis, founded solidly on morphology - thank you Pepper for your unparalleled contributions to this field! The opportunity to be your apprentice for five years has been a bigger and more positive influence than words can express.
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Affiliation(s)
- Maureen O'Sullivan
- National Children's Research Centre, Crumlin, Dublin, Ireland; Our Lady's Children's Hospital Crumlin, Dublin, Ireland; Trinity College, Dublin, Ireland.
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35
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Harel M, Ferrer FA, Shapiro LH, Makari JH. Future directions in risk stratification and therapy for advanced pediatric genitourinary rhabdomyosarcoma. Urol Oncol 2016; 34:103-15. [DOI: 10.1016/j.urolonc.2015.09.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/19/2015] [Accepted: 09/22/2015] [Indexed: 11/17/2022]
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