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Lim-Fat MJ, Bennett J, Ostrom Q, Touat M, Franceschi E, Schulte J, Bindra RS, Fangusaro J, Dhall G, Nicholson J, Jackson S, Davidson TB, Calaminus G, Robinson G, Whittle JR, Hau P, Ramaswamy V, Pajtler KW, Rudà R, Foreman NK, Hervey-Jumper SL, Das S, Dirks P, Bi WL, Huang A, Merchant TE, Fouladi M, Aldape K, Van den Bent MJ, Packer RJ, Miller JJ, Reardon DA, Chang SM, Haas-Kogan D, Tabori U, Hawkins C, Monje M, Wen PY, Bouffet E, Yeo KK. Central nervous system tumors in adolescents and young adults: A Society for Neuro-Oncology Consensus Review on diagnosis, management, and future directions. Neuro Oncol 2025; 27:13-32. [PMID: 39441704 PMCID: PMC11726256 DOI: 10.1093/neuonc/noae186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024] Open
Abstract
Adolescents and young adults (AYAs; ages 15-39 years) are a vulnerable population facing challenges in oncological care, including access to specialized care, transition of care, unique tumor biology, and poor representation in clinical trials. Brain tumors are the second most common tumor type in AYA, with malignant brain tumors being the most common cause of cancer-related death. The 2021 WHO Classification for central nervous system (CNS) Tumors highlights the importance of integrated molecular characterization with histologic diagnosis in several tumors relevant to the AYA population. In this position paper from the Society for Neuro-Oncology (SNO), the diagnosis and management of CNS tumors in AYA is reviewed, focusing on the most common tumor types in this population, namely glioma, medulloblastoma, ependymoma, and CNS germ cell tumor. Current challenges and future directions specific to AYA are also highlighted. Finally, possible solutions to address barriers in the care of AYA patients are discussed, emphasizing the need for multidisciplinary and collaborative approaches that span the pediatric and adult paradigms of care, and incorporating advanced molecular testing, targeted therapy, and AYA-centered care.
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Affiliation(s)
- Mary Jane Lim-Fat
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Julie Bennett
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Quinn Ostrom
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Mehdi Touat
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuro-oncologie, Paris, France
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna / AUSL di Bologna, Bologna, Italy
| | - Jessica Schulte
- Neurosciences Department, University of California San Diego, La Jolla, California, USA
| | - Ranjit S Bindra
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason Fangusaro
- Children’s Healthcare of Atlanta, Emory University, and the Aflac Cancer Center, Atlanta, Georgia, USA
| | - Girish Dhall
- Department of Hematology and Oncology, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - James Nicholson
- Paediatric Oncology, Cambridge University Hospitals and Department of Paediatrics, Cambridge University, UK
| | - Sadhana Jackson
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Tom Belle Davidson
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Gabriele Calaminus
- Paediatric Haematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Giles Robinson
- Department of Oncology, Neurobiology and Brain Tumor Program, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - James R Whittle
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Personalised Oncology Division, WEHI, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-Neuro-Oncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kristian W Pajtler
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Division of Pediatric Neuro-oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Hematology, Oncology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Roberta Rudà
- Division of Neuro-Oncology, Department Neuroscience Rita Levi Montalcini, University of Turin and City of Health and Science University Hospital, Turin, Italy
| | - Nicholas K Foreman
- Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Sunit Das
- Division of Neurosurgery, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Dirks
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Annie Huang
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Thomas E Merchant
- Department of Radiation Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Maryam Fouladi
- Division of Hematology/Oncology, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Roger J Packer
- Brain Tumor Institute, Gilbert Family Neurofibromatosis Institute, Center for Neuroscience and Behavioral Medicine, Children’s National Hospital, Washington, District of Columbia, USA
| | - Julie J Miller
- Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David A Reardon
- Center For Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Susan M Chang
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Daphne Haas-Kogan
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston Children’s Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA
| | - Uri Tabori
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia Hawkins
- Department of Pathology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Monje
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, California, USA
| | - Patrick Y Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Bouffet
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kee Kiat Yeo
- Department of Pediatric Oncology, Dana Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
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Aldape K, Capper D, von Deimling A, Giannini C, Gilbert MR, Hawkins C, Hench J, Jacques TS, Jones D, Louis DN, Mueller S, Orr BA, Nasrallah M, Pfister SM, Sahm F, Snuderl M, Solomon D, Varlet P, Wesseling P. cIMPACT-NOW update 9: Recommendations on utilization of genome-wide DNA methylation profiling for central nervous system tumor diagnostics. Neurooncol Adv 2025; 7:vdae228. [PMID: 39902391 PMCID: PMC11788596 DOI: 10.1093/noajnl/vdae228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2025] Open
Abstract
Genome-wide DNA methylation signatures correlate with and distinguish central nervous system (CNS) tumor types. Since the publication of the initial CNS tumor DNA methylation classifier in 2018, this platform has been increasingly used as a diagnostic tool for CNS tumors, with multiple studies showing the value and utility of DNA methylation-based classification of CNS tumors. A Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT-NOW) Working Group was therefore convened to describe the current state of the field and to provide advice based on lessons learned to date. Here, we provide recommendations for the use of DNA methylation-based classification in CNS tumor diagnostics, emphasizing the attributes and limitations of the modality. We emphasize that the methylation classifier is one diagnostic tool to be used alongside previously established diagnostic tools in a fully integrated fashion. In addition, we provide examples of the inclusion of DNA methylation data within the layered diagnostic reporting format endorsed by the World Health Organization (WHO) and the International Collaboration on Cancer Reporting. We emphasize the need for backward compatibility of future platforms to enable accumulated data to be compatible with new versions of the array. Finally, we outline the specific connections between methylation classes and CNS WHO tumor types to aid in the interpretation of classifier results. It is hoped that this update will assist the neuro-oncology community in the interpretation of DNA methylation classifier results to facilitate the accurate diagnosis of CNS tumors and thereby help guide patient management.
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Affiliation(s)
- Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MarylandUSA
| | - David Capper
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Caterina Giannini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, Bologna, Italy
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Cynthia Hawkins
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Hench
- Institut für Medizinische Genetik und Pathologie, Universitätsspital Basel, Basel, Switzerland
| | - Thomas S Jacques
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
- Paediatric Neuropathology, University College London, UCL GOS Institute of Child Health, London, UK
| | - David Jones
- Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - David N Louis
- Department of Pathology, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston Massachusetts, USA
| | - Sabine Mueller
- Department of Pediatric, University of Zurich, Zürich, Switzerland
- Department of Neurology, Neurosurgery, and Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Brent A Orr
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - MacLean Nasrallah
- Division of Neuropathology, Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stefan M Pfister
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Hopp Children´s Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Felix Sahm
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matija Snuderl
- Department of Pathology, New York University Langone Health and Grossman School of Medicine, New York, New York, USA
| | - David Solomon
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Pascale Varlet
- Department of Neuropathology, GHU Paris - Psychiatry and Neuroscience, Sainte-Anne Hospital, Paris, France
| | - Pieter Wesseling
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pathology, Amsterdam University Medical Centers/VU University, Amsterdam, The Netherlands
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Wagner MW, Jabehdar Maralani P, Bennett J, Nobre L, Lim-Fat MJ, Dirks P, Laughlin S, Tabori U, Ramaswamy V, Hawkins C, Ertl-Wagner BB. Brain Tumor Imaging in Adolescents and Young Adults: 2021 WHO Updates for Molecular-based Tumor Types. Radiology 2024; 310:e230777. [PMID: 38349246 DOI: 10.1148/radiol.230777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Published in 2021, the fifth edition of the World Health Organization (WHO) classification of tumors of the central nervous system (CNS) introduced new molecular criteria for tumor types that commonly occur in either pediatric or adult age groups. Adolescents and young adults (AYAs) are at the intersection of adult and pediatric care, and both pediatric-type and adult-type CNS tumors occur at that age. Mortality rates for AYAs with CNS tumors have increased by 0.6% per year for males and 1% per year for females from 2007 to 2016. To best serve patients, it is crucial that both pediatric and adult radiologists who interpret neuroimages are familiar with the various pediatric- and adult-type brain tumors and their typical imaging morphologic characteristics. Gliomas account for approximately 80% of all malignant CNS tumors in the AYA age group, with the most common types observed being diffuse astrocytic and glioneuronal tumors. Ependymomas and medulloblastomas also occur in the AYA population but are seen less frequently. Importantly, biologic behavior and progression of distinct molecular subgroups of brain tumors differ across ages. This review discusses newly added or revised gliomas in the fifth edition of the CNS WHO classification, as well as other CNS tumor types common in the AYA population.
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Affiliation(s)
- Matthias W Wagner
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Pejman Jabehdar Maralani
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Julie Bennett
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Liana Nobre
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Mary Jane Lim-Fat
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Peter Dirks
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Suzanne Laughlin
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Uri Tabori
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Vijay Ramaswamy
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Cynthia Hawkins
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Birgit B Ertl-Wagner
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
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4
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Bertero L, Mangherini L, Ricci AA, Cassoni P, Sahm F. Molecular neuropathology: an essential and evolving toolbox for the diagnosis and clinical management of central nervous system tumors. Virchows Arch 2024; 484:181-194. [PMID: 37658995 PMCID: PMC10948579 DOI: 10.1007/s00428-023-03632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
Molecular profiling has transformed the diagnostic workflow of CNS tumors during the last years. The latest WHO classification of CNS tumors (5th edition), published in 2021, pushed forward the integration between histopathological features and molecular hallmarks to achieve reproducible and clinically relevant diagnoses. To address these demands, pathologists have to appropriately deal with multiple molecular assays mainly including DNA methylation profiling and DNA/RNA next generation sequencing. Tumor classification by DNA methylation profiling is now a critical tool for many diagnostic tasks in neuropathology including the assessment of complex cases, to evaluate novel tumor types and to perform tumor subgrouping in hetereogenous entities like medulloblastoma or ependymoma. DNA/RNA NGS allow the detection of multiple molecular alterations including single nucleotide variations, small insertions/deletions (InDel), and gene fusions. These molecular markers can provide key insights for diagnosis, for example, if a tumor-specific mutation is detected, but also for treatment since targeted therapies are progressively entering the clinical practice. In the present review, a brief, but comprehensive overview of these tools will be provided, discussing their technical specifications, diagnostic value, and potential limitations. Moreover, the importance of molecular profiling will be shown in a representative series of CNS neoplasms including both the most frequent tumor types and other selected entities for which molecular characterization plays a critical role.
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Affiliation(s)
- Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin and Città Della Salute E Della Scienza University Hospital, Via Santena 7, 10126, Turin, Italy
| | - Luca Mangherini
- Pathology Unit, Department of Medical Sciences, University of Turin and Città Della Salute E Della Scienza University Hospital, Via Santena 7, 10126, Turin, Italy
| | - Alessia Andrea Ricci
- Pathology Unit, Department of Medical Sciences, University of Turin and Città Della Salute E Della Scienza University Hospital, Via Santena 7, 10126, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin and Città Della Salute E Della Scienza University Hospital, Via Santena 7, 10126, Turin, Italy
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.
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Pohl LC, Leitheiser M, Obrecht D, Schweizer L, Wefers AK, Eckhardt A, Raffeld M, Sturm D, Pajtler KW, Rutkowski S, Fukuoka K, Ichimura K, Bockmayr M, Schüller U. Molecular characteristics and improved survival prediction in a cohort of 2023 ependymomas. Acta Neuropathol 2024; 147:24. [PMID: 38265522 PMCID: PMC10808151 DOI: 10.1007/s00401-023-02674-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024]
Abstract
The diagnosis of ependymoma has moved from a purely histopathological review with limited prognostic value to an integrated diagnosis, relying heavily on molecular information. However, as the integrated approach is still novel and some molecular ependymoma subtypes are quite rare, few studies have correlated integrated pathology and clinical outcome, often focusing on small series of single molecular types. We collected data from 2023 ependymomas as classified by DNA methylation profiling, consisting of 1736 previously published and 287 unpublished methylation profiles. Methylation data and clinical information were correlated, and an integrated model was developed to predict progression-free survival. Patients with EPN-PFA, EPN-ZFTA, and EPN-MYCN tumors showed the worst outcome with 10-year overall survival rates of 56%, 62%, and 32%, respectively. EPN-PFA harbored chromosome 1q gains and/or 6q losses as markers for worse survival. In supratentorial EPN-ZFTA, a combined loss of CDKN2A and B indicated worse survival, whereas a single loss did not. Twelve out of 200 EPN-ZFTA (6%) were located in the posterior fossa, and these tumors relapsed or progressed even earlier than supratentorial tumors with a combined loss of CDKN2A/B. Patients with MPE and PF-SE, generally regarded as non-aggressive tumors, only had a 10-year progression-free survival of 59% and 65%, respectively. For the prediction of the 5-year progression-free survival, Kaplan-Meier estimators based on the molecular subtype, a Support Vector Machine based on methylation, and an integrated model based on clinical factors, CNV data, and predicted methylation scores achieved balanced accuracies of 66%, 68%, and 73%, respectively. Excluding samples with low prediction scores resulted in balanced accuracies of over 80%. In sum, our large-scale analysis of ependymomas provides robust information about molecular features and their clinical meaning. Our data are particularly relevant for rare and hardly explored tumor subtypes and seemingly benign variants that display higher recurrence rates than previously believed.
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Affiliation(s)
- Lara C Pohl
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
| | - Maximilian Leitheiser
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Pathology, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Denise Obrecht
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leonille Schweizer
- Institute of Neurology (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany
| | - Annika K Wefers
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alicia Eckhardt
- Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Radiotherapy and Radiation Oncology, Hubertus Wald Tumor Center-University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark Raffeld
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dominik Sturm
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kristian W Pajtler
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
- KiTZ Clinical Trial Unit, Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kohei Fukuoka
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Koichi Ichimura
- Department of Brain Disease Translational Research, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Michael Bockmayr
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Research Institute Children's Cancer Center Hamburg, Hamburg, Germany.
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Research Institute Children's Cancer Center Hamburg, Hamburg, Germany.
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Pratt D, Penas-Prado M, Gilbert MR. Clinical impact of molecular profiling in rare brain tumors. Curr Opin Neurol 2023; 36:579-586. [PMID: 37973025 DOI: 10.1097/wco.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the commonly used molecular diagnostics and illustrate the prognostic importance to the more accurate diagnosis that also may uncover therapeutic targets. RECENT FINDINGS The most recent WHO Classification of Central Nervous System Tumours (2021) lists over 100 distinct tumor types. While traditional histology continues to be an important component, molecular testing is increasingly being incorporated as requisite diagnostic criteria. Specific molecular findings such as co-deletion of the short arm of chromosome 1 (1p) and long arm of chromosome 19 (19q) now define IDH-mutant gliomas as oligodendroglioma. In recent years, DNA methylation profiling has emerged as a dynamic tool with high diagnostic accuracy. The integration of specific genetic (mutations, fusions) and epigenetic (CpG methylation) alterations has led to diagnostic refinement and the discovery of rare brain tumor types with distinct clinical outcomes. Molecular profiling is anticipated to play an increasing role in routine surgical neuropathology, although costs, access, and logistical concerns remain challenging. SUMMARY This review summarizes the current state of molecular testing in neuro-oncology highlighting commonly used and developing technologies, while also providing examples of new tumor types/subtypes that have emerged as a result of improved diagnostic precision.
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Affiliation(s)
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Cerretti G, Pessina F, Franceschi E, Barresi V, Salvalaggio A, Padovan M, Manara R, Di Nunno V, Bono BC, Librizzi G, Caccese M, Scorsetti M, Maccari M, Minniti G, Navarria P, Lombardi G. Spinal ependymoma in adults: from molecular advances to new treatment perspectives. Front Oncol 2023; 13:1301179. [PMID: 38074692 PMCID: PMC10704349 DOI: 10.3389/fonc.2023.1301179] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/24/2023] [Indexed: 12/21/2024] Open
Abstract
Ependymomas are rare glial tumors with clinical and biological heterogeneity, categorized into supratentorial ependymoma, posterior fossa ependymoma, and spinal cord ependymoma, according to anatomical localization. Spinal ependymoma comprises four different types: spinal ependymoma, spinal ependymoma MYCN-amplified, myxopapillary ependymoma, and subependymoma. The clinical onset largely depends on the spinal location of the tumor. Both non-specific and specific sensory and/or motor symptoms can be present. Owing to diverse features and the low incidence of spinal ependymomas, most of the current clinical management is derived from small retrospective studies, particularly in adults. Treatment involves primarily surgical resection, aiming at maximal safe resection. The use of radiotherapy remains controversial and the optimal dose has not been established; it is usually considered after subtotal resection for WHO grade 2 ependymoma and for WHO grade 3 ependymoma regardless of the extent of resection. There are limited systemic treatments available, with limited durable results and modest improvement in progression-free survival. Thus, chemotherapy is usually reserved for recurrent cases where resection and/or radiation is not feasible. Recently, a combination of temozolomide and lapatinib has shown modest results with a median progression-free survival (PFS) of 7.8 months in recurrent spinal ependymomas. Other studies have explored the use of temozolomide, platinum compounds, etoposide, and bevacizumab, but standard treatment options have not yet been defined. New treatment options with targeted treatments and immunotherapy are being investigated. Neurological and supportive care are crucial, even in the early stages. Post-surgical rehabilitation can improve the consequences of surgery and maintain a good quality of life, especially in young patients with long life expectancy. Here, we focus on the diagnosis and treatment recommendations for adults with spinal ependymoma, and discuss recent molecular advances and new treatment perspectives.
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Affiliation(s)
- Giulia Cerretti
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Federico Pessina
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessandro Salvalaggio
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
| | - Marta Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Renzo Manara
- Department of Neuroscience, Azienda Ospedale-Università di Padova, Padua, Italy
- Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Vincenzo Di Nunno
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Beatrice Claudia Bono
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Librizzi
- Department of Neuroscience, Azienda Ospedale-Università di Padova, Padua, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marta Maccari
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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