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Xie W, Zhang Y, Xu J, Sun F, Zhu J, Que Y, Huang J, Zhen Z, Lu S, Wang J, Zhang Y. Characteristics, treatments, and outcomes of adolescents and adults with neuroblastoma: a retrospective study in China. Ther Adv Med Oncol 2025; 17:17588359251337494. [PMID: 40351327 PMCID: PMC12064894 DOI: 10.1177/17588359251337494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Accepted: 04/08/2025] [Indexed: 05/14/2025] Open
Abstract
Background Neuroblastoma (NB) is rare in adolescents and adults, resulting in limited availability of data. Objectives We comprehensively investigated the characteristics, treatments, and outcomes of adolescent and adult patients with NB, aiming to provide a more in-depth insight into this disease. Design A retrospective, single-center study. Methods We retrieved and analyzed the medical data of patients with NB aged 10 years or older at diagnosis who were treated at Sun Yat-sen University Cancer Center between June 2005 and January 2024. Results Sixty-five patients (30 males and 35 females) were enrolled, with a median age of 20 years (interquartile range, 14-26 years), including 27 patients aged 10-18 years and 38 patients aged >18 years. Most patients were classified as M-stage disease (n = 40, 61.5%), high-risk (n = 42, 64.6%), and poorly differentiated NB (n = 27, 41.5%). Additionally, 3 (6.7%) patients had MYCN amplification, and 5 (25%) had ALK mutations. The genomic landscape revealed that mutations in the cell cycle and DNA repair pathways are related to chemotherapy sensitivity. After induction therapy, 34 (52.3%) patients achieved complete response (CR). The 5-year progression-free survival (PFS) and overall survival (OS) rates were 33.1% ± 6.9% and 55.1% ± 7.6%, respectively. Patients who achieved CR after induction therapy had superior PFS (p = 0.009), with 5-year PFS rates of 44.0% ± 10.6% compared to 18.5% ± 8.5% in non-CR patients. Conclusion Adolescent and adult patients with NB exhibit distinct characteristics, less chemotherapy sensitivity, and poorer outcomes compared to pediatric patients. Achieving CR after induction therapy is associated with better outcomes. Further investigation for new therapies is required.
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Affiliation(s)
- Weiji Xie
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Yu Zhang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Jiaqian Xu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Feifei Sun
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Jia Zhu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Yi Que
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Junting Huang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Zijun Zhen
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Suying Lu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Yuexiu District, Guangzhou City, Guangdong 510060, P.R. China
| | - Juan Wang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Yuexiu District, Guangzhou City, Guangdong 510060, P.R. China
| | - Yizhuo Zhang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Yuexiu District, Guangzhou City, Guangdong 510060, P.R. China
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Williams KM, Shah NR, Chukkapalli S, King S, Grant CN, Brown EG, Avanzini S, Lal DR, Sarnacki S, Newman EA. Modern surgical strategies in pediatric neuroblastoma: Evolving approaches and treatment principles. Pediatr Blood Cancer 2025; 72 Suppl 2:e31317. [PMID: 39313754 DOI: 10.1002/pbc.31317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024]
Abstract
Neuroblastoma, the most common extracranial solid tumor in children under the age of 5, has been described as early as the 19th century, and its complexity has continued to intrigue researchers, as well as medical and surgical specialists. At one end of the phenotypic spectrum, neuroblastoma is self-limiting with minimal to no intervention required, while on the opposite end exists the challenge of refractory disease despite aggressive management and toxic systemic treatments. The goal of this review is to describe a comprehensive surgical perspective and contemporary approach to neuroblastoma.
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Affiliation(s)
- Keyonna M Williams
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Nikhil R Shah
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Sahiti Chukkapalli
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah King
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Christa N Grant
- Department of Pediatric Surgery, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Erin G Brown
- Division of Pediatric Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Stefano Avanzini
- Department of Pediatric Surgery, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Dave R Lal
- Department of Pediatric Surgery, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Hôpital Universitaire Necker, Paris, France
| | - Erika A Newman
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Fusco JC, Abdelhafeez AH, Krauel L, Honeyman JN, Ehrlich PF, Wijnen M, Lautz TB, Pachl M, Malek MM. Imaging adjuvants in pediatric surgical oncology. Pediatr Blood Cancer 2025; 72 Suppl 2:e31241. [PMID: 39101518 DOI: 10.1002/pbc.31241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024]
Abstract
Surgery is a crucial component of pediatric cancer treatment, but conventional methods may lack precision. Image-guided surgery, including fluorescent and radioguided techniques, offers promise for enhancing tumor localization and facilitating precise resection. Intraoperative molecular imaging utilizes agents like indocyanine green to direct surgeons to occult deposits of tumor and to delineate tumor margins. Next-generation agents target tumors directly to improve specificity. Radioguided surgery, employing tracers like metaiodobenzylguanidine (MIBG), complements fluorescent techniques by allowing for detection of tumors at a greater depth. Dual-labeled agents combining both modalities are under development. Three-dimensional modeling and virtual/augmented reality aid in preoperative planning and intraoperative guidance. The above techniques show great promise to benefit patients with pediatric tumors, and their continued development will almost certainly improve surgical outcomes.
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Affiliation(s)
- Joseph C Fusco
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Lucas Krauel
- Department of Surgery, St. Joan de Deu Barcelona Children's Hospital, Barcelona, Spain
| | - Joshua N Honeyman
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Peter F Ehrlich
- Division of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc Wijnen
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Timothy B Lautz
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Max Pachl
- Department of Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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4
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Avanzini S, Sarnacki S, Urla C, Parodi S, Palo F, Benissad M, Crocoli A, Buconi I, Flores P, Bordallo Vazquez M, Irtan S, Hompes D, Virgone C, Metzelder M, Matthyssens L, Gabra H, Jauquier N, Fuchs J, Losty PD, Dall'Igna P. Development of a New Score Based on Image Defined Risk Factors to Standardize Surgical Risk in Neuroblastoma Resection - A SIOPEN Collaborative Study. J Pediatr Surg 2025; 60:162108. [PMID: 39729919 DOI: 10.1016/j.jpedsurg.2024.162108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 12/09/2024] [Indexed: 12/29/2024]
Abstract
BACKGROUND AND AIMS Image Defined Risk Factors (IDRFs) assess surgical risk in neuroblastoma (NB) and guide neoadjuvant therapy. Despite chemotherapy IDRFs may persist in 70 % of cases. Several studies have suggested that not all IDRFs hold equal significance and that the presence of an IDRF does not inherently signify unresectability. This current study seeks to stratify and assign a score to each IDRF based on its impact on surgical risk. METHODS This collaborative study entailed retrospective collection of patient data from NB operations conducted between 2016 and 2020, together with the computation of a Surgical Complexity Index (SCI) for every patient. The SCI values obtained were correlated with preoperatively identified IDRFs. Mann-Whitney statistical test was employed to assign a relevance score to the association between individual IDRFs and SCI. RESULTS 14 centers contributed 427 neuroblastoma index cases meeting study inclusion criteria. 303 patients had 1 or more IDRFs. The presence and number of IDRFs in all patients significantly correlated with the SCI value (p < 0.0001). The most frequently encountered IDRF was renal pedicle involvement. There was a significant association observed between clusters of abdominal IDRFs and the occurrence of post-operative complications (p < 0.05), while a weak association link was found with intra-operative complications. A relevance score for individual IDRFs allowed their stratification based on surgical risk. The most relevant IDRFs were extension within two anatomical body compartments, infiltration of the hepato-pancreatic block, encasement of the superior mesenteric artery and coeliac axis, and tumor compressing the trachea. CONCLUSIONS This current study has facilitated the assignment of a relevance score to each IDRF, correlating it with surgical risks. Considering this stratification of surgical risk alongside oncologic risk as defined by the neuroblastoma treatment patient risk grouping should facilitate a more precise definition of surgical objectives and the optimal conditions favoring gross tumor resection. TYPE OF STUDY Clinical Research - Study of Diagnostic Test. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Stefano Avanzini
- Pediatric Surgery Department - IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Urology and Transplantation, Hospital Necker Enfants Malades, APHP Centre, Université de Paris Cité, France
| | - Cristian Urla
- Department of Pediatric Surgery and Pediatric Urology, University of Tuebingen, Germany
| | - Stefano Parodi
- Epidemiology and Biostatistics Unit, Scientific Directorate- IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Federico Palo
- Pediatric Surgery Department - IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Melissa Benissad
- Department of Pediatric Surgery, Urology and Transplantation, Hospital Necker Enfants Malades, APHP Centre, Université de Paris Cité, France
| | - Alessandro Crocoli
- Surgical Oncology Unit - IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Ilaria Buconi
- Surgical Oncology Unit - IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Paula Flores
- Pediatric Surgery Department Garrahan Hospital, Buenos Aires, Argentina
| | - Maria Bordallo Vazquez
- Department of Pediatric Surgery, Surgical Oncology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Sabine Irtan
- Sorbonne Université, Department of Visceral Pediatric and Neonatal Surgery, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Daphne Hompes
- Department of Surgical Oncology, University Hospitals Gasthuisberg Leuven, Belgium
| | - Calogero Virgone
- Department of Women's and Children's Health, Pediatric Surgery Division, University Hospital of Padova, Italy; Pediatric Surgery, University Hospital of Padova, Padua, Italy
| | - Martin Metzelder
- Department of Pediatric and Adolescent Surgery, Medical University of Vienna, Vienna, Austria
| | - Lucas Matthyssens
- Department of Gastrointestinal and Pediatric Surgery, Princess Elisabeth Children's Hospital, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Hany Gabra
- Department of Paediatric Surgery, The Great North Children Hospital, Newcastle University Hospitals Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicolas Jauquier
- Department of Child and Adolescent Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jorg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University of Tuebingen, Germany
| | - Paul D Losty
- Institute of Systems Molecular and Integrative Biology University of Liverpool, UK; Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Patrizia Dall'Igna
- Pediatric Surgery, Dipartimento di Medicina di Precisione e Rigenerativa a Area Jonica, Azienda Ospedaliera-Universitaria Consorziale Ospedale Pediatrico Giovanni XXIII, Bari, Italy
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5
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Koelker-Wolfe E, Marcus KJ, DuBois SG, Catalano PJ, Shusterman S, Ioakeim-Ioannidou M, Elhalawani H, Yock TI, MacDonald SM, Haas-Kogan DA, Liu KX. Hypofractionated Palliative Radiotherapy for Relapsed and Refractory High-Risk Neuroblastoma. Curr Oncol 2025; 32:124. [PMID: 40136328 PMCID: PMC11941608 DOI: 10.3390/curroncol32030124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 02/18/2025] [Accepted: 02/20/2025] [Indexed: 03/27/2025] Open
Abstract
Introduction: While palliative radiotherapy (RT) is frequently used in the management of relapsed/refractory high-risk neuroblastoma (HR-NBL); outcomes after palliative hypofractionated RT (hypo-RT) remain poorly characterized. Methods: We conducted a multi-institutional retrospective study of 38 patients who were diagnosed with HR-NBL between 1997 and 2021 and received palliative RT. Conventional RT (conv-RT) and hypo-RT were defined as palliative treatment courses using dose ≤2 or >2 Gy per fraction, respectively. The primary outcome was cumulative incidence of in-field progression using Gray's test. Univariate analyses were performed using the Cox proportional hazards model. Results: When analyzing by first course of palliative RT, 16 patients received conventionally fractionated RT (43%) and 21 received hypo-RT (57%). Clinical characteristics were similar between the two groups. With a median follow-up of 10.3 months (range: 0.3-104.0), the cumulative incidence of in-field progression was not statistically significantly different between hypo-RT and conv-RT (30% vs. 20% at 10 months; p = 0.80). Clinical response, defined as symptomatic improvement or decrease in the size of the lesion, was not statistically different between the two groups (92% conv-RT vs. 90% hypo-RT; p = 1.00). No grade ≥4 toxicities were observed. On univariate analysis, hypo-RT (HR 1.50; 95% CI 0.47-4.76; p = 0.493) was not statistically significantly associated with time to in-field progression, but MYCN amplification was associated with significantly longer time to in-field progression (HR: 0.20; 95% CI: 0.05-0.77; p = 0.020). Conclusions: We found no statistically significant difference in cumulative incidence of in-field progression and clinical outcomes between the conv-RT and hypo-RT groups. Palliative hypo-RT can be considered for relapsed/refractory HR-NBL, especially when shorter treatments may offer improved quality of life.
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Affiliation(s)
- Ellery Koelker-Wolfe
- Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (E.K.-W.); (K.J.M.); (H.E.); (D.A.H.-K.)
| | - Karen J. Marcus
- Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (E.K.-W.); (K.J.M.); (H.E.); (D.A.H.-K.)
| | - Steven G. DuBois
- Department of Pediatrics, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA 02115, USA; (S.G.D.); (S.S.)
| | - Paul J. Catalano
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Suzanne Shusterman
- Department of Pediatrics, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA 02115, USA; (S.G.D.); (S.S.)
| | - Myrsini Ioakeim-Ioannidou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA; (M.I.-I.); (T.I.Y.); (S.M.M.)
| | - Hesham Elhalawani
- Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (E.K.-W.); (K.J.M.); (H.E.); (D.A.H.-K.)
| | - Torunn I. Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA; (M.I.-I.); (T.I.Y.); (S.M.M.)
| | - Shannon M. MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA; (M.I.-I.); (T.I.Y.); (S.M.M.)
| | - Daphne A. Haas-Kogan
- Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (E.K.-W.); (K.J.M.); (H.E.); (D.A.H.-K.)
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA; (M.I.-I.); (T.I.Y.); (S.M.M.)
| | - Kevin X. Liu
- Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (E.K.-W.); (K.J.M.); (H.E.); (D.A.H.-K.)
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA; (M.I.-I.); (T.I.Y.); (S.M.M.)
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6
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Stokes R, Bannon A, Leung B, Alloo J, Davies-Payne D, Winstanley M, Wood A, Evans S, Hamill J. Vascular encasement image defined risk factors independently predict surgical complications in neuroblastoma. ANZ J Surg 2025. [PMID: 39887919 DOI: 10.1111/ans.19420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 07/03/2024] [Accepted: 01/16/2025] [Indexed: 02/01/2025]
Abstract
BACKGROUND Specific image defined risk factors (IDRF) immediately prior to surgery may be more relevant to paediatric oncology surgeons than pre-neoadjuvant IDRFs at diagnosis. The aim of this study was to determine IDRF subtypes that independently predict postoperative complications. METHODS We searched the New Zealand Children's Cancer Registry for all cases of neuroblastoma treated at a single paediatric oncology centre between January 2007 and February 2021 and determined the IDRF status on pre-operative imaging at diagnosis and after neoadjuvant therapy. Surgical complications (Clavien-Dindo grade) were correlated with total number of IDRFs (pre- and post-chemotherapy) and three subsets: vascular encasement (VE), invasive (I), and extensive (E). RESULTS Of 101 patients, 73 underwent surgical resection, and 32 (44%) had a surgical complication. Of the 54 IDRF-positive tumours, all were treated by neoadjuvant therapy and in 17, all IDRFs resolved. Complications correlated with the number of post-neoadjuvant therapy VE-IDRFs at OR 1.2 (95% CI 1.0-1.4, P = 0.02) and extensive IDRFs at OR 1.7 (95% CI 1.1-1.9, P = 0.02). Pre-neoadjuvant IDRF status was not independently associated with complications when controlling for post-neoadjuvant IDRF status. The total number of VE-IDRF reduced from 181 pre-neoadjuvant therapy to 86 post, with tumour encasing the aorta and/or vena cava being the most common. CONCLUSIONS The vascular encasement and extensive subtypes of IDRF may be more useful prognostic indicators of surgical complications than the total number of IDRFs. This may have implications for reporting IDRF status on preoperative imaging and surgical planning but needs validation in larger cohort studies.
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Affiliation(s)
- Rachael Stokes
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Aidan Bannon
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Bonnie Leung
- Department of Radiology, Starship Children's Hospital, Auckland, New Zealand
| | - Jasmin Alloo
- Department of Oncology, Starship Children's Hospital, Auckland, New Zealand
| | - David Davies-Payne
- Department of Radiology, Starship Children's Hospital, Auckland, New Zealand
| | - Mark Winstanley
- Department of Oncology, Starship Children's Hospital, Auckland, New Zealand
| | - Andrew Wood
- Department of Oncology, Starship Children's Hospital, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Stephen Evans
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - James Hamill
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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7
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Sever RE, Rosenblum LT, Stanley KC, Cortez AG, Menendez DM, Chagantipati B, Nedrow JR, Edwards WB, Malek MM, Kohanbash G. Detection properties of indium-111 and IRDye800CW for intraoperative molecular imaging use across tissue phantom models. JOURNAL OF BIOMEDICAL OPTICS 2025; 30:S13705. [PMID: 39310036 PMCID: PMC11413652 DOI: 10.1117/1.jbo.30.s1.s13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/12/2024] [Accepted: 08/26/2024] [Indexed: 09/25/2024]
Abstract
Significance Intraoperative molecular imaging (IMI) enables the detection and visualization of cancer tissue using targeted radioactive or fluorescent tracers. While IMI research has rapidly expanded, including the recent Food and Drug Administration approval of a targeted fluorophore, the limits of detection have not been well-defined. Aim The ability of widely available handheld intraoperative tools (Neoprobe and SPY-PHI) to measure gamma decay and fluorescence intensity from IMI tracers was assessed while varying characteristics of both the signal source and the intervening tissue or gelatin phantoms. Approach Gamma decay signal and fluorescence from tracer-bearing tumors (TBTs) and modifiable tumor-like inclusions (TLIs) were measured through increasing thicknesses of porcine tissue and gelatin in custom 3D-printed molds. TBTs buried beneath porcine tissue were used to simulate IMI-guided tumor resection. Results Gamma decay from TBTs and TLIs was detected through significantly thicker tissue and gelatin than fluorescence, with at least 5% of the maximum signal observed through up to 5 and 0.5 cm, respectively, depending on the overlying tissue type or gelatin. Conclusions We developed novel systems that can be fine-tuned to simulate variable tumor characteristics and tissue environments. These were used to evaluate the detection of fluorescent and gamma signals from IMI tracers and simulate IMI surgery.
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Affiliation(s)
- ReidAnn E. Sever
- University of Pittsburgh, Department of Neurological Surgery, Pittsburgh, Pennsylvania, United States
| | - Lauren T. Rosenblum
- University of Pittsburgh, Department of Surgery, Pittsburgh, Pennsylvania, United States
| | - Kayla C. Stanley
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Angel G. Cortez
- University of Pittsburgh Medical Center, In Vivo Imaging Facility Core, Hillman Cancer Center, Pittsburgh, Pennsylvania, United States
| | - Dominic M. Menendez
- University of Missouri, Department of Biochemistry, Columbia, Missouri, United States
| | - Bhuvitha Chagantipati
- University of Pittsburgh, Department of Neurological Surgery, Pittsburgh, Pennsylvania, United States
| | - Jessie R. Nedrow
- University of Pittsburgh Medical Center, In Vivo Imaging Facility Core, Hillman Cancer Center, Pittsburgh, Pennsylvania, United States
| | - W. Barry Edwards
- University of Missouri, Department of Biochemistry, Columbia, Missouri, United States
| | - Marcus M. Malek
- University of Pittsburgh, Department of Surgery, Pittsburgh, Pennsylvania, United States
- University of Pittsburgh School of Medicine, Division of Pediatric General and Thoracic Surgery, Department of Surgery, Pittsburgh, Pennsylvania, United States
| | - Gary Kohanbash
- University of Pittsburgh, Department of Neurological Surgery, Pittsburgh, Pennsylvania, United States
- University of Pittsburgh, Department of Immunology, Pittsburgh, Pennsylvania, United States
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8
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Samim A, Littooij AS, Peters M, de Keizer B, van der Steeg AFW, Fajardo RD, Kraal KCJM, Dierselhuis MP, van Eijkelenburg NKA, van Grotel M, Polak R, van de Ven CP, Wijnen MHWA, Seravalli E, Willemsen-Bosman ME, van Noesel MM, Tytgat GAM, Janssens GO. Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions. Radiother Oncol 2025; 202:110604. [PMID: 39481605 DOI: 10.1016/j.radonc.2024.110604] [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: 07/27/2024] [Revised: 10/24/2024] [Accepted: 10/25/2024] [Indexed: 11/02/2024]
Abstract
INTRODUCTION Radiotherapy protocols for high-risk neuroblastoma (HR-NBL) vary across international studies. The purpose of this study was to evaluate the locoregional control in a national HR-NBL cohort treated with highly-conformal image-guided radiotherapy (IGRT), using reduced margins, and a boost dose for residual lesions. MATERIALS AND METHODS Patients treated with radiotherapy as part of first-line HR-NBL treatment between 2015 and 2022 were eligible. To obtain clinical, internal, and planning target volumes, +0.5 cm, 4DCT-based, and + 0.3/0.5 cm margins, respectively, were added to the edited gross tumour volumes. Prescription dose was 21.6/1.8 Gy, followed by 14.4/1.8 Gy for any residual lesions measuring ≥ 1 cm3 at the time of radiotherapy planning. Intensity-modulated arc therapy was combined with daily cone beam CT-based online patient position verification. Locoregional failure (LRF) rates were compared for the presence of residual lesions < 1 cm3 vs. ≥ 1 cm3 (with/without locoregional activity on nuclear- and MRI[diffusion-weighted imaging]-scans) pre-radiotherapy, age at diagnosis, MYCN-status, [131I]mIBG therapy, response to induction chemotherapy, interval to radiotherapy onset, and metastatic site irradiation. RESULTS Among the 77 included patients, 34 had residual lesions (median volume: 10.0 cm3, IQR 4.8-29.9) with activity visible on 17 nuclear- and 10 MRI-scans. Five-year LRF rate was 7.8 % (95 % confidence interval 1.8-13.8), and not significantly different between those with residual lesions < 1 cm3 vs. ≥ 1 cm3 (6.4 % vs. 14.3 %, respectively, p = 0.27), or any of the other variables. All 6 LRFs (2 isolated, 4 combined) occurred < 1.5 years post-radiotherapy. CONCLUSION In HR-NBL, IGRT with reduced margins and a boost dose for residual lesions ≥ 1 cm3 demonstrated excellent locoregional control, comparable to modern literature.
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Affiliation(s)
- Atia Samim
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annemieke S Littooij
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart de Keizer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Raquel Dávila Fajardo
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | - Roel Polak
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Marc H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Godelieve A M Tytgat
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
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9
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Shakeel A, Baloch A, Kumari V, Kazmi SKZ, Aftab K, Abid S, Syed A, Yousuf J, Hasanain M, Anjum MU, Mahmmoud Fadelallah Eljack M. Iwilfin (eflornithine) approved by the FDA as the first and only oral maintenance therapy for high-risk neuroblastoma in adult and pediatric patients: Narrative review. Medicine (Baltimore) 2024; 103:e40662. [PMID: 39612452 PMCID: PMC11608686 DOI: 10.1097/md.0000000000040662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 11/06/2024] [Indexed: 12/01/2024] Open
Abstract
Neural crest progenitor cells give rise to neuroblasts, the growing nerve cells of the sympathetic nervous system. These cells can undergo changes leading to neuroblastoma, a malignancy responsible for 15% of all pediatric cancer-related deaths. The molecular pathogenesis of this pediatric cancer involves complex genetic alterations, such as MYCN amplification, chromosomal abnormalities, and gene expression changes. Despite aggressive therapies, survival rates for children with high-risk neuroblastoma (HRNB) have not improved significantly compared to those with less severe forms of the disease. This highlights the challenge of managing HRNB and underscores the need for new, effective treatments. A comprehensive treatment regimen, including immunotherapy, radiation therapy, myeloablative chemotherapy, and surgical removal, has been employed to achieve remission in HRNB patients. While dinutuximab beta immunotherapy is an effective and widely used treatment, it has several potential side effects that must be carefully monitored. New drugs are being developed to reduce these side effects without compromising efficacy. One such drug is DL-alpha-difluoromethylornithine (DFMO), approved by the FDA under the brand name Iwilfin. Numerous clinical trials have shown that DFMO, when used as maintenance therapy, significantly improves event-free survival and overall survival in neuroblastoma patients. However, DFMO has adverse effects that require continuous monitoring. Further research is needed to minimize these side effects and improve its efficacy, particularly in addressing resistance caused by long-term use.
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Affiliation(s)
- Ayesha Shakeel
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Aniqa Baloch
- Department of Medicine and Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Versha Kumari
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Kanza Aftab
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Shiza Abid
- Department of Medicine and Surgery, Ayub Medical College, Abbottabad, Pakistan
| | - Amna Syed
- Department of Medicine and Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Juvairia Yousuf
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Muhammad Hasanain
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Muhammad Umair Anjum
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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10
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Rosenblum LT, Sever RE, Gilbert R, Guerrero D, Vincze SR, Menendez DM, Birikorang PA, Rodgers MR, Jaswal AP, Vanover AC, Latoche JD, Cortez AG, Day KE, Foley LM, Sneiderman CT, Raphael I, Hitchens TK, Nedrow JR, Kohanbash G, Edwards WB, Malek MM. Dual-labeled anti-GD2 targeted probe for intraoperative molecular imaging of neuroblastoma. J Transl Med 2024; 22:940. [PMID: 39407274 PMCID: PMC11476241 DOI: 10.1186/s12967-024-05728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 10/01/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND Surgical resection is integral for the treatment of neuroblastoma, the most common extracranial solid malignancy in children. Safely locating and resecting primary tumor and remote deposits of disease remains a significant challenge, resulting in high rates of complications and incomplete surgery, worsening outcomes. Intraoperative molecular imaging (IMI) uses targeted radioactive or fluorescent tracers to identify and visualize tumors intraoperatively. GD2 was selected as an IMI target, as it is highly overexpressed in neuroblastoma and minimally expressed in normal tissue. METHODS GD2 expression in neuroblastoma cell lines was measured by flow cytometry. DTPA and IRDye® 800CW were conjugated to anti-GD2 antibody to generate DTPA-αGD2-IR800. Binding affinity (Kd) of the antibody and the non-radiolabeled tracer were then measured by ELISA assay. Human neuroblastoma SK-N-BE(2) cells were surgically injected into the left adrenal gland of 3.5-5-week-old nude mice and the orthotopic xenograft tumors grew for 5 weeks. 111In-αGD2-IR800 or isotype control tracer was administered via tail vein injection. After 4 and 6 days, mice were euthanized and gamma and fluorescence biodistributions were measured using a gamma counter and ImageJ analysis of acquired SPY-PHI fluorescence images of resected organs (including tumor, contralateral adrenal, kidneys, liver, muscle, blood, and others). Organ uptake was compared by one-way ANOVA (with a separate analysis for each tracer/day combination), and if significant, Sidak's multiple comparison test was used to compare the uptake of each organ to the tumor. Handheld tools were also used to detect and visualize tumor in situ, and to assess for residual disease following non-guided resection. RESULTS 111In-αGD2-IR800 was successfully synthesized with 0.75-2.0 DTPA and 2-3 IRDye® 800CW per antibody and retained adequate antigen-binding (Kd = 2.39 nM for aGD2 vs. 21.31 nM for DTPA-aGD2-IR800). The anti-GD2 tracer demonstrated antigen-specific uptake in mice with human neuroblastoma xenografts (gamma biodistribution tumor-to-blood ratios of 3.87 and 3.88 on days 4 and 6 with anti-GD2 tracer), while isotype control tracer did not accumulate (0.414 and 0.514 on days 4 and 6). Probe accumulation in xenografts was detected and visualized using widely available operative tools (Neoprobe® and SPY-PHI camera) and facilitated detection ofputative residual disease in the resection cavity following unguided resection. CONCLUSIONS We have developed a dual-labeled anti-GD2 antibody-based tracer that incorporates In-111 and IRDye® 800CW for radio- and fluorescence-guided surgery, respectively. The tracer adequately binds to GD2, specifically accumulates in GD2-expressing xenograft tumors, and enables tumor visualization with a hand-held NIR camera. These results encourage the development of 111In-αGD2-IR800 for future use in children with neuroblastoma, with the goal of improving patient safety, completeness of resection, and overall patient outcomes.
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Affiliation(s)
- Lauren Taylor Rosenblum
- Department of General Surgery, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - ReidAnn E Sever
- Department of Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, 7131 Rangos Research Building, 530 45th Street, Pittsburgh, PA, 15201, USA
| | - Ryan Gilbert
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA
| | - David Guerrero
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Sarah R Vincze
- Department of Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, 7131 Rangos Research Building, 530 45th Street, Pittsburgh, PA, 15201, USA
| | - Dominic M Menendez
- Department of Biochemistry, University of Missouri, 117 Schweitzer Hall, Columbia, MO, 65211, USA
| | - Peggy A Birikorang
- Department of Biochemistry, University of Missouri, 117 Schweitzer Hall, Columbia, MO, 65211, USA
| | - Mikayla R Rodgers
- Department of Biochemistry, University of Missouri, 117 Schweitzer Hall, Columbia, MO, 65211, USA
| | - Ambika Parmar Jaswal
- Department of Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, 7131 Rangos Research Building, 530 45th Street, Pittsburgh, PA, 15201, USA
| | - Alexander C Vanover
- Department of Biochemistry, University of Missouri, 117 Schweitzer Hall, Columbia, MO, 65211, USA
| | - Joseph D Latoche
- In Vivo Imaging Facility Core, Hillman Cancer Center, University of Pittsburgh Medical Center, 5115 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Angel G Cortez
- In Vivo Imaging Facility Core, Hillman Cancer Center, University of Pittsburgh Medical Center, 5115 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Kathryn E Day
- In Vivo Imaging Facility Core, Hillman Cancer Center, University of Pittsburgh Medical Center, 5115 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Lesley M Foley
- In Vivo Imaging Facility Core, Hillman Cancer Center, University of Pittsburgh Medical Center, 5115 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Chaim T Sneiderman
- Department of Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, 7131 Rangos Research Building, 530 45th Street, Pittsburgh, PA, 15201, USA
| | - Itay Raphael
- Department of Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, 7131 Rangos Research Building, 530 45th Street, Pittsburgh, PA, 15201, USA
| | - T Kevin Hitchens
- In Vivo Imaging Facility Core, Hillman Cancer Center, University of Pittsburgh Medical Center, 5115 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Jessie R Nedrow
- In Vivo Imaging Facility Core, Hillman Cancer Center, University of Pittsburgh Medical Center, 5115 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Gary Kohanbash
- Department of Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, 7131 Rangos Research Building, 530 45th Street, Pittsburgh, PA, 15201, USA.
- Department of Immunology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - W Barry Edwards
- Department of Biochemistry, University of Missouri, 117 Schweitzer Hall, Columbia, MO, 65211, USA
| | - Marcus M Malek
- Department of General Surgery, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
- Department of Pediatric General Surgery, University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Ave., Faculty Pavilion 7th Floor, Pittsburgh, PA, 15224, USA.
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11
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Espinoza AF, Bagatell R, McHugh K, Naranjo AH, Van Ryn C, Rojas Y, Lyons K, Paul Guillerman R, Kirby C, Brock P, Volchenboum S, Simon T, States L, Miller A, Krug B, Sarnacki S, Irtan S, Brisse HJ, Valteau-Couanet D, von Schweinitz D, Kammer B, Granata C, Pio L, Park JR, Nuchtern JG. A subset of image-defined risk factors predict completeness of resection in children with high-risk neuroblastoma: An international multicenter study. Pediatr Blood Cancer 2024; 71:e31218. [PMID: 39072986 PMCID: PMC11500268 DOI: 10.1002/pbc.31218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/16/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Image-defined risk factors (IDRFs) were promulgated for predicting the feasibility and safety of complete primary tumor resection in children with neuroblastoma (NB). There is limited understanding of the impact of individual IDRFs on resectability of the primary tumor or patient outcomes. A multicenter database of patients with high-risk NB was interrogated to answer this question. DESIGN/METHODS Patients with high-risk NB (age <20 years) were eligible if cross-sectional imaging was performed at least twice prior to resection. IDRFs and primary tumor measurements were recorded for each imaging study. Extent of resection was determined from operative reports. RESULTS There were 211 of 229 patients with IDRFs at diagnosis, and 171 patients with IDRFs present pre-surgery. A ≥90% resection was significantly more likely in the absence of tumor invading or encasing the porta hepatis, hepatoduodenal ligament, superior mesenteric artery (SMA), renal pedicles, abdominal aorta/inferior vena cava (IVC), iliac vessels, and/or diaphragm at diagnosis or an overlapping subset of IDRFs (except diaphragm) at pre-surgery. There were no significant differences in event-free survival (EFS) and overall survival (OS) when patients were stratified by the presence versus absence of any IDRF either at diagnosis or pre-surgery. CONCLUSION Two distinct but overlapping subsets of IDRFs present either at diagnosis or after induction chemotherapy significantly influence the probability of a complete resection in children with high-risk NB. The presence of IDRFs was not associated with significant differences in OS or EFS in this cohort.
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Affiliation(s)
| | | | - Kieran McHugh
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Arlene H Naranjo
- University of Florida Colleges of Medicine and Public Health & Health Professions, Children’s Oncology Group Statistics & Data Center, Gainesville, USA
| | - Collin Van Ryn
- University of Florida Colleges of Medicine and Public Health & Health Professions, Children’s Oncology Group Statistics & Data Center, Gainesville, USA
| | - Yesenia Rojas
- Texas Children’s Hospital/Baylor College of Medicine, Houston, USA
| | - Karen Lyons
- Texas Children’s Hospital/Baylor College of Medicine, Houston, USA
| | | | | | - Penelope Brock
- Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Thorsten Simon
- Department of Radiology, University of Cologne, Cologne, Germany
| | - Lisa States
- Children’s Hospital of Philadelphia, Philadelphia, USA
| | | | - Barbara Krug
- Department of Radiology, University of Cologne, Cologne, Germany
| | - Sabine Sarnacki
- Necker-Enfants Malades Hospital – APHP and Université de Paris Cité, Paris, France
| | - Sabine Irtan
- Necker-Enfants Malades Hospital – APHP and Université de Paris Cité, Paris, France
| | | | | | - Dietrich von Schweinitz
- Department of Radiology, LMU University Hospital, LMU, University of Munich, Munich, Germany
| | - Birgit Kammer
- Department of Radiology, LMU University Hospital, LMU, University of Munich, Munich, Germany
| | | | - Luca Pio
- Giannina Gaslini Children’s Hospital, Genoa, Italy
- St. Jude Children’s Research Hospital, Memphis, USA
| | | | - Jed G. Nuchtern
- Texas Children’s Hospital/Baylor College of Medicine, Houston, USA
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12
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Yan Z, Wu Y, Chen Y, Xu J, Zhang X, Yin Q. A clinical prediction model for distant metastases of pediatric neuroblastoma: an analysis based on the SEER database. Front Pediatr 2024; 12:1417818. [PMID: 39363969 PMCID: PMC11447546 DOI: 10.3389/fped.2024.1417818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 09/03/2024] [Indexed: 10/05/2024] Open
Abstract
Background Patients with distant metastases from neuroblastoma (NB) usually have a poorer prognosis, and early diagnosis is essential to prevent distant metastases. The aim was to develop a machine-learning model for predicting the risk of distant metastasis in patients with neuroblastoma to aid clinical diagnosis and treatment decisions. Methods We built a predictive model using data from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2018 on 1,542 patients with neuroblastoma. Seven machine-learning methods were employed to forecast the likelihood of neuroblastoma distant metastases. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for building machine learning models. Secondly, the subject operating characteristic area under the curve (AUC), Precision-Recall (PR) curves, decision curve analysis (DCA), and calibration curves were used to assess model performance. To further explain the optimal model, the Shapley summation interpretation method (SHAP) was applied. Ultimately, the best model was used to create an online calculator that estimates the likelihood of neuroblastoma distant metastases. Results The study included 1,542 patients with neuroblastoma, multifactorial logistic regression analysis showed that age, histology, tumor size, tumor grade, primary site, surgery, chemotherapy, and radiotherapy were independent risk factors for distant metastasis of neuroblastoma (P < 0.05). Logistic regression (LR) was found to be the optimal algorithm among the seven constructed, with the highest AUC values of 0.835 and 0.850 in the training and validation sets, respectively. Finally, we used the logistic regression model to build a network calculator for distant metastasis of neuroblastoma. Conclusion The study developed and validated a machine learning model based on clinical and pathological information for predicting the risk of distant metastasis in patients with neuroblastoma, which may help physicians make clinical decisions.
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Affiliation(s)
- Zhiwei Yan
- Department of Paediatric Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Yumeng Wu
- Cancer Research Center Nantong, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Yuehua Chen
- Department of Pediatric Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Jian Xu
- Department of Medical Oncology, Nantong Second Peoples Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xiubing Zhang
- Department of Medical Oncology, Nantong Second Peoples Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Qiyou Yin
- Department of Pediatric Surgery, Affiliated Hospital of Nantong University, Nantong, China
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13
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Liu KX, Shaaban SG, Chen JJ, Bagatell R, Lerman BJ, Catalano PJ, DuBois SG, Shusterman S, Ioakeim-Ioannidou M, Yock TI, Shamberger RC, Mattei P, Vu L, Elhalawani H, Dusenbery KE, Vo KT, Huang MS, Friedmann AM, Diller LR, Marcus KJ, MacDonald SM, Terezakis SA, Braunstein SE, Hill-Kayser CE, Haas-Kogan DA. Patterns of recurrence after radiotherapy for high-risk neuroblastoma: Implications for radiation dose and field. Radiother Oncol 2024; 198:110384. [PMID: 38880415 DOI: 10.1016/j.radonc.2024.110384] [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: 01/09/2024] [Revised: 05/29/2024] [Accepted: 06/12/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Prognosis for patients with high-risk neuroblastoma (HR-NBL) is guarded despite aggressive therapy, and few studies have characterized outcomes after radiotherapy in relation to radiation treatment fields. METHODS Multi-institutional retrospective cohort of 293 patients with HR-NBL who received autologous stem cell transplant (ASCT) and EBRT between 1997-2021. LRR was defined as recurrence at the primary site or within one nodal echelon beyond disease present at diagnosis. Follow-up was defined from the end of EBRT. Event-free survival (EFS) and OS were analyzed by Kaplan-Meier method. Cumulative incidence of locoregional progression (CILP) was analyzed using competing risks of distant-only relapse and death with Gray's test. RESULTS Median follow-up was 7.0 years (range: 0.01-22.4). Five-year CILP, EFS, and OS were 11.9 %, 65.2 %, and 77.5 %, respectively. Of the 31 patients with LRR and imaging review, 15 (48.4 %) had in-field recurrences (>12 Gy), 6 (19.4 %) had marginal failures (≤12 Gy), and 10 (32.3 %) had both in-field and marginal recurrences. No patients receiving total body irradiation (12 Gy) experienced marginal-only failures (p = 0.069). On multivariable analyses, MYCN amplification had higher risk of LRR (HR: 2.42, 95 % CI: 1.06-5.50, p = 0.035) and post-consolidation isotretinoin and anti-GD2 antibody therapy (HR: 0.42, 95 % CI: 0.19-0.94, p = 0.035) had lower risk of LRR. CONCLUSIONS Despite EBRT, LRR remains a contributor to treatment failure in HR-NBL with approximately half of LRRs including a component of marginal failure. Future prospective studies are needed to explore whether radiation fields and doses should be defined based on molecular features such as MYCN amplification, and/or response to chemotherapy.
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Affiliation(s)
- Kevin X Liu
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sherif G Shaaban
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jie Jane Chen
- Department of Radiation Oncology, University of California at San Francisco, UCSF Benioff Children's Hospital, San Francisco, CA, USA; Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rochelle Bagatell
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin J Lerman
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pediatrics, UCSF Benioff Children's Hospital and UCSF School of Medicine, San Francisco, CA, USA
| | - Paul J Catalano
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, and Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steven G DuBois
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Suzanne Shusterman
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Myrsini Ioakeim-Ioannidou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert C Shamberger
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Mattei
- Department of Surgery, University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lan Vu
- Department of Surgery, UCSF Benioff Children's Hospital and UCSF School of Medicine, San Francisco, CA, USA
| | - Hesham Elhalawani
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathryn E Dusenbery
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Kieuhoa T Vo
- Department of Pediatrics, UCSF Benioff Children's Hospital and UCSF School of Medicine, San Francisco, CA, USA
| | - Mary S Huang
- Department of Pediatric Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Alison M Friedmann
- Department of Pediatric Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa R Diller
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Karen J Marcus
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Steve E Braunstein
- Department of Radiation Oncology, University of California at San Francisco, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Christine E Hill-Kayser
- Department of Radiation Oncology, University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Raitio A, Losty PD. Incidence and Risk Factors for Chyle Leaks After Neuroblastic Tumor Resection: A Systematic Review of Published Studies. J Pediatr Surg 2024; 59:1611-1614. [PMID: 38490882 DOI: 10.1016/j.jpedsurg.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Chyle leakage/ascites after surgical resection of neuroblastic tumors may delay the start of chemotherapy and worsen prognosis. Previous studies have reported a highly variable incidence and risk factors remain largely unknown. This study aims to analyze the true incidence of chyle leaks and ascites and seeks to identify risk factors and optimal treatment strategies. METHODS Medline/Embase databases were searched according to PRISMA guidelines. Literature reviews, case reports, and non-English papers were excluded. Data were extracted independently following paper selection by 2 authors. RESULTS The final analysis yielded 15 studies with N = 1468 patients. Chylous ascites was recorded postoperatively in 171 patients (12%). Most patients experiencing chyle leaks were successfully treated conservatively with drainage, bowel rest, parenteral nutrition and octreotide with variable combinations of these treatment options. 7/171 (4%) patients required operative exploration to control troublesome persistent chyle leaks. In risk factor analysis, higher tumor stage was significantly associated with the risk of chyle leak (P < 0.0001) whereas no correlation was observed with adrenal vs non-adrenal tumor location, INRG risk groups and tumor laterality. CONCLUSION Chyle leakage after surgery for neuroblastic tumors is a common morbid complication occurring in some 12% of patients. Higher INSS tumor stage portends greater risk(s). Conservative therapy strategies appear successful in the majority of cases. To avert this complication meticulous mesenteric lymphatic ligation is recommended especially for those patients with higher tumor stage(s) requiring extensive radical surgery including retroperitoneal lymph node resection. LEVEL OF EVIDENCE III. TYPE OF STUDY Systematic review.
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Affiliation(s)
- Arimatias Raitio
- University of Turku and Turku University Hospital, Paediatric Surgery, Turku, Finland.
| | - Paul D Losty
- Institute of Systems and Molecular Biology, University of Liverpool, Liverpool, UK; Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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15
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Cernaianu G, Franke G, Kühne NE, Meurer M, Trobs RB, Eifinger F, Dübbers M, Scaal M, Vahdad R. Cadaveric analysis of surgical techniques and working space for retroperitoneal tumors as model for improving resection of neuroblastoma. BMC Surg 2024; 24:220. [PMID: 39080686 PMCID: PMC11289930 DOI: 10.1186/s12893-024-02508-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: 12/31/2023] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
PURPOSE Neuroblastoma, the most common extracranial solid tumor in children under 5 years, often surrounds visceral arteries. This study aimed to analyze the working space provided by standardized surgical techniques at key arterial landmarks in adult cadavers. METHODS We assessed in eight adult cadavers the mobilization of the left colon, spleen and pancreas, right colon, duodenum and mesenteric root, access to the bursa omentalis. The average working space score (AWSS) was evaluated at the left and right renal artery, left and right side of the coeliac trunk, superior mesenteric and common hepatic artery. The score was defined as: (0) vessel not visible, (1) working space at the vessel ≤ 1x diameter of the aorta, (2) < 3x the diameter of the aorta, (3) ≥ 3x diameter of the aorta. RESULTS The maximum AWSS of 3 was achieved at key vascular landmarks through specific mobilization techniques. CONCLUSION Additional mobilization of spleen, pancreas and mesenteric root and access to the bursa omentalis increase surgical working space at major visceral arteries. The results of our investigation provide surgeons with a useful guide to prepare for abdominal neuroblastoma resection.
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Affiliation(s)
- Grigore Cernaianu
- Division of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Greta Franke
- Division of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany
| | - Nora Elena Kühne
- Division of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany
| | - Miriam Meurer
- Division of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany
| | - Ralf-Bodo Trobs
- Department of Pediatric Surgery and Pediatric Orthopedics, St. Hedwig Clinic, Steinmetzstraße 1-3, 93049, Regensburg, Germany
| | - Frank Eifinger
- Department of Pediatric Critical Care Medicine and Neonatology, University Hospital Cologne, Kerpenerstr. 62, 50937, Cologne, Germany
| | - Martin Dübbers
- Division of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany
| | - Martin Scaal
- Department of Anatomy, Faculty of Medicine, University of Cologne, Joseph-Stelzmann Str. 9, 50931, Köln, Germany
| | - Reza Vahdad
- Department of Pediatric Surgery, University Hospital of Marburg, 35043, Baldingerstraße, Marburg, Germany
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16
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Yoneda A, Shichino H, Hishiki T, Matsumoto K, Ohira M, Kamijo T, Kuroda T, Soejima T, Nakazawa A, Takimoto T, Yokota I, Teramukai S, Takahashi H, Fukushima T, Hara J, Kaneko M, Ikeda H, Tajiri T, Mugishima H, Nakagawara A. A nationwide phase II study of delayed local treatment for children with high-risk neuroblastoma: The Japan Children's Cancer Group Neuroblastoma Committee Trial JN-H-11. Pediatr Blood Cancer 2024; 71:e30976. [PMID: 38577760 DOI: 10.1002/pbc.30976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/15/2024] [Accepted: 02/13/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Survival rates of patients with high-risk neuroblastoma are unacceptable. A time-intensified treatment strategy with delayed local treatment to control systemic diseases has been developed in Japan. We conducted a nationwide, prospective, single-arm clinical trial with delayed local treatment. This study evaluated the safety and efficacy of delayed surgery to increase treatment intensity. PATIENTS AND METHODS Seventy-five patients with high-risk neuroblastoma were enrolled in this study between May 2011 and September 2015. Delayed local treatment consisted of five courses of induction chemotherapy (cisplatin, pirarubicin, vincristine, and cyclophosphamide) and myeloablative high-dose chemotherapy (melphalan, etoposide, and carboplatin), followed by local tumor extirpation with surgery and irradiation. The primary endpoint was progression-free survival (PFS). The secondary endpoints were overall survival (OS), response rate, adverse events, and surgical complications. RESULTS Seventy-five patients were enrolled, and 64 were evaluable (stage 3, n = 8; stage 4, n = 56). The estimated 3-year PFS and OS rates (95% confidence interval [CI]) were 44.4% [31.8%-56.3%] and 80.7% [68.5%-88.5%], resspectively. The response rate of INRC after completion of the treatment protocol was 66% (42/64; 95% CI: 53%-77%; 23 CR [complete response], 10 VGPR [very good partial response], and nine PR [partial response]). None of the patients died during the protocol treatment or within 30 days of completion. Grade 4 adverse effects, excluding hematological adverse effects, occurred in 48% of patients [31/64; 95% CI: 36%-61%]. Major Surgical complications were observed in 25% of patients [13/51; 95% CI: 14%-40%]. CONCLUSION This study indicates that delayed local treatment is feasible and shows promising efficacy, suggesting that this treatment should be considered further in a comparative study of high-risk neuroblastoma.
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Affiliation(s)
- Akihiro Yoneda
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Surgery, Surgical Oncology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
- Pediatric Surgical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Shichino
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatrics, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomoro Hishiki
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatric Surgery, Chiba University, Chiba, Japan
| | - Kimikazu Matsumoto
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Miki Ohira
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Research Institute for Clinical Oncology, Saitama Cancer Center, Saitama, Japan
| | - Takehiko Kamijo
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Research Institute for Clinical Oncology, Saitama Cancer Center, Saitama, Japan
| | - Tatsuo Kuroda
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Toshinori Soejima
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Kobe Proton Center, Kobe, Japan
| | - Atsuko Nakazawa
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Clinical Research, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Takimoto
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Clinical Epidemiology Research Center for Pediatric Cancer, National Center for Child Health and Development, Tokyo, Japan
| | - Isao Yokota
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Biostatistics, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Satoshi Teramukai
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideto Takahashi
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- National Institute of Public Health, Saitama, Japan
| | - Takashi Fukushima
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Department of Pediatric Hematology and Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Junichi Hara
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatric Hematology and Oncology, Osaka City General Hospital, Osaka, Japan
| | - Michio Kaneko
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Ibaraki Prefectural Association of Health Evaluation and Promotion, Mito, Japan
| | - Hitoshi Ikeda
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatric Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Tatsuro Tajiri
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideo Mugishima
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Booth Memorial Aged Care Center GRACE, Tokyo, Japan
| | - Akira Nakagawara
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- SAGA Heavy Ion Medical Accelerator in Tosu, Tosu, Japan
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17
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Jacobson JC, Qiao J, Cochran ED, McCreery S, Chung DH. Migration, invasion, and metastasis are mediated by P-Rex1 in neuroblastoma. Front Oncol 2024; 14:1336031. [PMID: 38884093 PMCID: PMC11176429 DOI: 10.3389/fonc.2024.1336031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/08/2024] [Indexed: 06/18/2024] Open
Abstract
Neuroblastoma accounts for approximately 15% of pediatric cancer-related deaths despite intensive multimodal therapy. This is due, in part, to high rates of metastatic disease at diagnosis and disease relapse. A better understanding of tumor biology of aggressive, pro-metastatic phenotypes is necessary to develop novel, more effective therapeutics against neuroblastoma. Phosphatidylinositol 3,4,5-trisphosphate-dependent Rac exchanger 1 (P-Rex1) has been found to stimulate migration, invasion, and metastasis in several adult malignancies. However, its role in neuroblastoma is currently unknown. In the present study, we found that P-Rex1 is upregulated in pro-metastatic murine models of neuroblastoma, as well as human neuroblastoma metastases. Correspondingly, silencing of P-Rex1 was associated with decreased migration and invasion in vitro. This was associated with decreased AKT-mTOR and ERK2 activity, dysregulation of Rac, and diminished secretion of matrix metalloproteinases. Furthermore, increased P-Rex1 expression was associated with inferior relapse-free and overall survival via tissue microarray and Kaplan-Meier survival analysis of a publicly available clinical database. Together, these findings suggest that P-Rex1 may be a novel therapeutic target and potential prognostic factor in neuroblastoma.
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Affiliation(s)
- Jillian C Jacobson
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, United States
| | - Jingbo Qiao
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, United States
| | - Elizabeth D Cochran
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, United States
| | - Sullivan McCreery
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, United States
| | - Dai H Chung
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, United States
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18
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Feng J, Mou J, Yang S, Ren Q, Chang S, Yang W, Cheng H, Chang X, Zhu Z, Han J, Qin H, Wang H, Ni X. Risk factors, impact and treatment of postoperative lymphatic leakage in children with abdominal neuroblastoma operated on by laparotomy. BMC Surg 2024; 24:168. [PMID: 38811926 PMCID: PMC11134958 DOI: 10.1186/s12893-024-02459-3] [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: 09/29/2023] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Lymphatic leakage is one of the postoperative complications of neuroblastoma. The purpose of this study is to summarize the clinical characteristics and risk factors of lymphatic leakage and try to find effective prevention and treatment measures. METHODS A retrospective study included 186 children with abdominal neuroblastoma, including 32 children of lymphatic leakage and 154 children of non-lymphatic leakage. The clinical information, surgical data, postoperative abdominal drainage, treatment of lymphatic leakage and prognosis of the two groups were collected and analyzed. RESULTS The incidence of lymphatic leakage in this cohort was 14% (32 children). Through univariate analysis of lymphatic leakage group and non-lymphatic leakage group, we found that lymphatic leakage increased the complications, prolonged the time of abdominal drainage and hospitalization, and delayed postoperative chemotherapy (p < 0.05). In this cohort, the median follow-up time was 46 (95% CI: 44-48) months. The follow-up data of 7 children were partially missing. 147 children survived, of which 23 had tumor recurrence (5 children recurred in the surgical area). 37 children died, of which 32 had tumor recurrence (9 children recurred in the operation area). In univariate analysis, there was no statistical difference in overall survival (p = 0.21) and event-free survival (p = 0.057) between lymphatic leakage group and non-lymphatic leakage group, while 3-year cumulative incidence of local progression was higher in lymphatic leakage group (p = 0.015). However, through multivariate analysis, we found that lymphatic leakage did not affect event-free survival, overall survival and cumulative incidence of local progression in children with neuroblastoma. Resection of 5 or more lymphatic regions was an independent risk factor for lymphatic leakage after neuroblastoma surgery. All 32 children with lymphatic leakage were cured by conservative treatment without surgery. Of these, 75% (24/32) children were cured by fat-free diet or observation, 25% (8/32) children were cured by total parenteral nutrition. The median drain output at diagnosis in total parenteral nutrition group was higher than that in non-total parenteral nutrition group (p < 0.001). The cut-off value was 17.2 ml/kg/day. CONCLUSIONS Lymphatic leakage does not affect the prognosis of children with neuroblastoma, but long-term drain output caused by lymphatic leakage will still adversely affect postoperative complications and follow-up treatment, which requires attention and active treatment measures. More attention should be paid to the children with 5 or more lymphatic regions resection, and the injured lymphatic vessels should be actively found and ligated after tumor resection to reduce the postoperative lymphatic leakage. Early application of total parenteral nutrition is recommended for those who have drain output at diagnosis of greater than 17.2 ml/kg/day. LEVEL OF EVIDENCE Level III, Treatment study (Retrospective comparative study).
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Affiliation(s)
- Jun Feng
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jianing Mou
- Children's Hospital, Capital Institute of Pediatrics, 2# Yabao Road, Chaoyang District, Beijing, 100020, China
| | - Shen Yang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Qinghua Ren
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Saishuo Chang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wei Yang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Haiyan Cheng
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiaofeng Chang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhiyun Zhu
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jianyu Han
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hong Qin
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Huanmin Wang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Xin Ni
- Beijing Children's Hospital, National Center for Pediatric Cancer Surveillance, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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19
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Staniorski CJ, Malek MM, Waltz PK, Reyes-Múgica M, Ost MC. Pelvic Neuroblastoma of the Pediatric Prostate. Urology 2024; 187:82-85. [PMID: 38401809 DOI: 10.1016/j.urology.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/04/2024] [Indexed: 02/26/2024]
Abstract
Neuroblastoma accounts for a significant portion of childhood tumors and can present in a variety of ways. Pelvic neuroblastoma has been reported but few cases exist of neuroblastoma invading or originating from the bladder or prostate. We present a 4-year-old patient with pelvic neuroblastoma arising from the prostate and describe the medical and surgical management of this challenging case. While pelvic neuroblastoma may have an improved prognosis, this case demonstrates the challenging surgical decisions that accompany these patients to maintain quality of life while balancing oncologic efficacy of treatment.
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Affiliation(s)
- Christopher J Staniorski
- Division of Pediatric Urology, Department of Urology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Paul K Waltz
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Miguel Reyes-Múgica
- Division of Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Michael C Ost
- Division of Pediatric Urology, Department of Urology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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20
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Takenouchi A, Kudo W, Terui K, Komatsu S, Oita S, Yoshizawa H, Kawaguchi Y, Fumita T, Nishimura K, Hishiki T. Impaired Aortic Growth in Neuroblastoma Patients After Intensive Treatment. J Pediatr Surg 2024; 59:593-598. [PMID: 38184434 DOI: 10.1016/j.jpedsurg.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE This study evaluated the abdominal aortic diameter in high-risk neuroblastoma (NB) patients and the risk of aortic narrowing following intensive treatment. METHODS We measured the aortic diameter at four specific levels of the abdominal aorta (diaphragmatic crus, celiac axis, and the root of the superior (SMA) and inferior (IMA) mesenteric arteries) on contrast CT scans. The control group consisted of 56 children with non-oncologic disorders, while the NB group included 35 patients with high-risk abdominal NB. We used regression analysis of age and aortic diameter to determine the regression formula for each level in each group and performed intergroup comparisons using t-test. RESULTS We evaluated a total of 160 contrast-enhanced CTs performed in the 35 eligible cases. The aortic diameter of pretreated NB patients was not significantly different from the controls. After receiving any treatment, the aortic diameter was significantly smaller in the NB group (p < 0.01 each). Patients who underwent radical surgery, particularly gross total resection (n = 26), had smaller aortic diameters at all levels compared to controls (p < 0.01 each). Patients treated with radiotherapy (RT) had smaller aortic diameters than controls. External beam radiotherapy (EBRT) patients (n = 24) had smaller aortic diameters at all levels except the celiac axis (crus, SMA, IMA; p < 0.01 each), and intraoperative radiotherapy (IORT) ± EBRT patients (n = 5) had smaller aortic diameters at all levels (p < 0.01 each). CONCLUSION Patients with NB may experience impaired development of the abdominal aorta after multimodal therapy, particularly after RT. Close observation and long-term follow-up is essential to monitor for catastrophic vascular complications. LEVEL OF EVIDENCE LEVEL III.
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Affiliation(s)
- Ayako Takenouchi
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Wataru Kudo
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keita Terui
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shugo Komatsu
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoru Oita
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroko Yoshizawa
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yunosuke Kawaguchi
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Fumita
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Katsuhiro Nishimura
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoro Hishiki
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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21
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Gow KW, Lautz TB, Malek MM, Cost NG, Newman EA, Dasgupta R, Christison-Lagay ER, Tiao GM, Davidoff AM. Children's Oncology Group's 2023 blueprint for research: Surgery. Pediatr Blood Cancer 2024; 71:e30766. [PMID: 37950538 PMCID: PMC10872730 DOI: 10.1002/pbc.30766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
Surgery plays a crucial role in the treatment of children with solid malignancies. A well-conducted operation is often essential for cure. Collaboration with the primary care team is important for determining if and when surgery should be performed, and if performed, an operation must be done in accordance with well-established standards. The long-term consequences of surgery also need to be considered. Indications and objectives for a procedure vary. Providing education and developing and analyzing new research protocols that include aims relevant to surgery are key objectives of the Surgery Discipline of the Children's Oncology Group. The critical evaluation of emerging technologies to ensure safe, effective procedures is another key objective. Through research, education, and advancing technologies, the role of the pediatric surgeon in the multidisciplinary care of children with solid malignancies will continue to evolve.
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Affiliation(s)
- Kenneth W. Gow
- Division of General & Thoracic Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Timothy B. Lautz
- Department of Pediatric Surgery, Lurie Children’s Hospital of Chicago, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Marcus M. Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas G. Cost
- Department of Surgery, Division of Urology and the Surgical Oncology Program, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Erika A. Newman
- Department of Surgery, Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Emily R. Christison-Lagay
- Division of Pediatric Surgery, Yale School of Medicine, Yale-New Haven Children’s Hospital, New Haven, Connecticut, USA
| | - Gregory M. Tiao
- Division of Pediatric General and Thoracic Surgery, Cincinnati Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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22
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Krivonosov AA, Minnullin MM, Akhaladze DG, Grachev NS. [Surgery for abdominal neuroblastoma in children]. Khirurgiia (Mosk) 2024:152-160. [PMID: 38785252 DOI: 10.17116/hirurgia2024051152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
This review is devoted to surgical approach for neurogenic tumors in children. The authors discuss epidemiological data, history of surgical approaches, preoperative imaging and risk factors. A special attention is paid to the influence of surgical interventions for various neuroblastomas on overall and event-free survival in pediatric population, as well as the most common surgical complications and modern approaches to their treatment.
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Affiliation(s)
- A A Krivonosov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - M M Minnullin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - D G Akhaladze
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - N S Grachev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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23
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Du J, Yuan X. Analysis of the incidence, characteristics, and risk factors of complications during induction chemotherapy in children with high-risk neuroblastoma. Eur J Pediatr 2024; 183:185-202. [PMID: 37855927 DOI: 10.1007/s00431-023-05273-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
Patients with high-risk neuroblastoma (HR-NB) exhibit suboptimal 5-year survival rates, leading to a widespread international preference for high-intensity chemotherapeutic regimens in these children. We analyzed the incidence and risk factors for complications during induction chemotherapy in children with HR-NB and tried to assist clinicians in predicting such complications and optimizing therapeutic strategy. The clinical data of children with HR-NB admitted to our hospital from January 2007 to December 2019 were retrospectively analyzed. The incidence, characteristics, and risk factors of complications (infection, hemorrhage, and chemotherapy-related adverse reactions (CRAR)) requiring hospitalization during induction chemotherapy in these children were explored. (1) A total of 108 patients with HR-NB were included in the final analysis. The overall infection rate was 92.6% (100/108), with the highest incidence of 71.3% observed during the first cycle. FN, bacterial infection, as well as fungal infection were common infectious complications in children with HR-NB during induction chemotherapy. (2) The overall hemorrhage rate was 24.1% (26/108), with the highest incidence of 14.8% also observed in the first cycle. Among the children with hemorrhage, there were 72% with bone marrow involved, while 65.0% of them had a high vanillylmandelic acid (VMA) value. And children with hemorrhage also exhibited neuron-specific enolase (NSE) ≥ 200 µg/L in 88.5% of cases and lactic dehydrogenase (LDH) ≥ 1000U/L in 73.1% of cases. (3) The incidence of CRAR rate was 100%, and 99.1% (107/108) patients experienced myelosuppression. The incidence of myelosuppression peaked in the third cycle, reaching up to 85.2%. Most children suffered severe myelosuppression existed with bone marrow metastases (76.3%), abnormal VMA (67.5%), and LDH ≥ 1000 U/L (60%). (4) Non-myelosuppressive adverse effects were observed in 75.9% children (82/108), with the highest incidence occurring in the third cycle at 42.6%. (5) Patients who experienced three types of complications had a lower median survival time (MST) of 54.4 months, a 3-year event-free survival (EFS) rate of (44.2 ± 10.7)%, and a 3-year overall survival (OS) rate of (75.8 ± 8.6)%, in comparison to those with only one or two complications, who had a higher MST of 59.5 months, a 3-year EFS rate of (73.5 ± 5.2)% (X2 = 10.457, P = 0.001), and a 3-year OS rate of (84.8 ± 4.1)% (X2 = 10.511, P = 0.001). CONCLUSION The presence of bone marrow involved and increased VMA were high-risk factors for infection, while NSE ≥ 200 µg/L and LDH ≥ 1000 U/L were high-risk factors for hemorrhage. For those children who had experienced severe myelosuppression, the presence of bone marrow metastases, increased VMA, and LDH ≥ 1000 U/L were their risk factors. The presence of bone involvement was a high-risk factor for children to have non-myelosuppressive adverse effects. Complications that arise during induction chemotherapy could negatively impact the children's prognosis and overall quality of life. WHAT IS KNOWN • The high-risk neuroblastoma (HR-NB) had a worse prognosis; there was a general international preference for high-intensity chemotherapeutic regimens in the induction phase to these children. WHAT IS NEW • We analyzed the incidence and risk factors of complications during induction chemotherapy in children with HR-NB and tried to help clinicians predict such complications and adopt optimized therapeutic strategy.
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Affiliation(s)
- Jiaxi Du
- Department of Pediatric Hematology/Oncology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Yuan
- Department of Pediatric Hematology/Oncology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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24
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Sever RE, Rosenblum LT, Reyes-Múgica M, Edwards WB, Malek MM, Kohanbash G. Survival following complete resection of neuroblastoma in novel orthotopic rat xenograft model. Sci Rep 2023; 13:20214. [PMID: 37980388 PMCID: PMC10657433 DOI: 10.1038/s41598-023-47537-3] [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: 10/02/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023] Open
Abstract
Neuroblastoma accounts for 15% of pediatric cancer deaths, despite multimodal therapy including surgical resection. Current neuroblastoma rodent models are insufficient for studying the impact of surgery and combination treatments, largely due to the small size of mouse models. Human neuroblastoma SK-N-BE(2) cells were injected into the left adrenal gland of 5-6-week-old RNU homozygous nude rats. Rats were either monitored by MRI until humane endpoint was reached or after 5 weeks underwent operative tumor resection, followed by monitoring for recurrence and survival. Following neuroblastoma cell implantation, the majority of tumors grew to greater than 5000 mm3 within 5.5-6.5 weeks, meeting the humane endpoint. Surgical resection was successfully done in 8 out of 9 rats, extending survival following tumor implantation from a median of 42 days to 78 days (p < 0.005). Pathology was consistent with human neuroblastoma, showing small round blue cell tumors with Homer-Wright rosettes, high mitoses and karyorrhectic index, and strong PHOX2B staining. Thus, we have established a novel orthotopic xenograft rat model of neuroblastoma and demonstrated increased survival of rats after surgical tumor resection. This model can be used for the development of surgical techniques, such as the use of intraoperative molecular imaging or assessment of combination therapies that include surgery.
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Affiliation(s)
- ReidAnn E Sever
- Department of Neurological Surgery, University of Pittsburgh, 530 45th Street, Pittsburgh, PA, 15201, USA
| | - Lauren Taylor Rosenblum
- Department of Surgery, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Miguel Reyes-Múgica
- Department of Pathology, UPMC Children's Hospital of Pittsburgh, One Children's Hospital Drive, 4401 Penn Ave, Pittsburgh, PA, 15224, USA
| | - W Barry Edwards
- Department of Biochemistry, University of Missouri, 117 Schweitzer Hall, Columbia, MO, 65211, USA
| | - Marcus M Malek
- Department of Surgery, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
- Department of Pediatric General Surgery, University of Pittsburgh, One Children's Hospital Drive, 4401 Penn Ave, Pittsburgh, PA, 15224, USA.
| | - Gary Kohanbash
- Department of Neurological Surgery, University of Pittsburgh, 530 45th Street, Pittsburgh, PA, 15201, USA.
- Department of Immunology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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25
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Shaffiey SA, Le HD, Christison-Lagay E, Fialkowski EA, Aldrink JH, Grant CN, Honeyman JN, Janek KC, Madonna MB, Rhee DS, Nuchtern JG, Newman EA, LaQuaglia MP, Davidoff AM, Shamberger RC, Malek MM. Critical elements of pediatric neuroblastoma surgery. Semin Pediatr Surg 2023; 32:151338. [PMID: 38042090 DOI: 10.1016/j.sempedsurg.2023.151338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
Neuroblastoma (NB) is the most common solid extracranial malignancy of childhood with an incidence of 1 per 100,000 in the United States compromising approximately 10 % of childhood cancer. Unfortunately, patients with high-risk NG continue to have long-term survival less than 50 %. Both Children's Oncology Group and the International Society of Paediatric Oncology have demonstrated the important role of surgery in the treatment of high-risk NB. Herein, we compose the results of an extensive literature review as well as expert opinion from leaders in pediatric surgical oncology, to present the critical elements of effective surgery for high-risk neuroblastoma.
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Affiliation(s)
| | - Hau D Le
- University of Wisconsin-Madison, Madison WI 53705, USA
| | | | | | - Jennifer H Aldrink
- Nationwide Children's Hospital OSU College of Medicine, Columbus, OH 43205, USA
| | - Christa N Grant
- Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY 10595, USA
| | | | - Kevin C Janek
- Children's Hospital of Michigan, Detroit, MI 48201, USA
| | | | | | - Jed G Nuchtern
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA
| | | | | | | | | | - Marcus M Malek
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
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26
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Krystal J, Foster JH. Treatment of High-Risk Neuroblastoma. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1302. [PMID: 37628301 PMCID: PMC10453838 DOI: 10.3390/children10081302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
High-risk neuroblastoma is a highly aggressive solid tumor that most commonly presents in early childhood. Advances in treatment through decades of clinical trials and research have led to improved outcomes. This review provides an overview of the current state of treatment for high-risk neuroblastoma.
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Affiliation(s)
- Julie Krystal
- Zucker Hofstra School of Medicine, Department of Pediatrics, Cohen Children’s Medical Center, New Hyde Park, NY 11040, USA
| | - Jennifer H. Foster
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Cancer Center, Houston, TX 77030, USA;
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27
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Zarfati A, Martucci C, Persano G, Cassanelli G, Crocoli A, Madafferi S, Natali GL, De Ioris MA, Inserra A. Preoperative Spinal Angiography for Thoracic Neuroblastoma: Impact of Identification of the Adamkiewicz Artery on Gross Total Resection and Neurological Sequelae. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1116. [PMID: 37508612 PMCID: PMC10378327 DOI: 10.3390/children10071116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Patients with thoracic neuroblastoma (TNB) are at high risk of postoperative neurologic complications due to iatrogenic lesions of the artery of Adamkiewicz (AKA). The role of performing a preoperative spinal angiography (POSA) in these patients must be clarified. The present study sought to further understand the relationship between POSA and TNB, as well as the effects of identifying the AKA on surgical excision and neurological consequences. METHODS Data from patients with TNB who underwent POSA between November 2015 and February 2022 at our tertiary pediatric center were retrospectively analyzed. RESULTS Six patients were identified, five of whom (83%) were considered eligible for surgical excision. Gross total resection (GTR) was achieved in three patients (60%), which included two patients with an AKA contralateral to the tumor, and one with an homolateral AKAl. After a median follow-up of 4.1 years from diagnosis, no patients developed neurological complications; five (83%) were alive and well, and one died from refractory recurrence. CONCLUSIONS Among patients with TNB, POSA was useful for identifying the AKA and defining the optimal surgical strategy. POSA should be considered in the preoperative evaluation of TNB to increase the likelihood of GTR and reduce the threats of iatrogenic neurologic sequelae.
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Affiliation(s)
- Angelo Zarfati
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Cristina Martucci
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Giorgio Persano
- Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Giulia Cassanelli
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Silvia Madafferi
- Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Gian Luigi Natali
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Maria Antonietta De Ioris
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
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28
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Karalexi MA, Servitzoglou M, Papadakis V, Kachanov D, Česen Mazič M, Baka M, Moschovi M, Kourti M, Polychronopoulou S, Stiakaki E, Hatzipantelis E, Dana H, Stefanaki K, Malama A, Themistocleous MS, Strantzia K, Shamanskaya T, Bouka P, Panagopoulou P, Kantzanou M, Ntzani E, Dessypris N, Petridou ET. Survival patterns of childhood neuroblastoma: an analysis of clinical data from Southern-Eastern European countries. Eur J Cancer Prev 2023; 32:254-263. [PMID: 32925511 DOI: 10.1097/cej.0000000000000614] [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: 11/27/2022]
Abstract
The prognosis of children with neuroblastoma (NBL) can be dismal with significant variations depending on the stage and biology of the tumor. We assessed the event-free (EFS) and overall (OS) survival using harmonized data from three Southern-Eastern European (SEE) countries. Data for 520 incident NBL cases (2009-2018) were collected from Greece, Slovenia and Russia. Kaplan-Meier curves were fitted, and EFS/OS were derived from Cox proportional models by study variables including the protocol-based risk-group (low/observation, intermediate, high). Over one-third of cases were coded in the high-risk group, of which 23 children (4.4%) received treatment with anti-ganglioside 2 (GD2) mAb. Survival rates were inferior in older (OS 5-year; 1.5-4.9 years: 61%; EFS 5-year; 1.5-4.9 years: 48%) compared to children younger than 1.5 years (OS 5-year; <1.5 years: 91%; EFS 5-year; <1.5 years: 78%). Predictors of poor OS included stage 4 (hazard ratio, HR OS : 18.12, 95% confidence intervals, CI: 3.47-94.54), N-myc amplification (HR OS : 2.16, 95% CI: 1.40-3.34), no surgical excision (HR OS : 3.27, 95% CI: 1.91-5.61) and relapse/progression (HR OS : 5.46, 95% CI: 3.23-9.24). Similar unfavorable EFS was found for the same subsets of patients. By contrast, treatment with anti-GD2 antibody in high-risk patients was associated with decreased risk of death or unfavorable events (HR OS : 0.11, 95% CI: 0.02-0.79; HR EFS : 0.19, 95% CI: 0.07-0.52). Our results confirm the outstanding prognosis of the early NBL stages, especially in children <1.5 years, and the improved outcomes of the anti-GD2 treatment in high-risk patients. Ongoing high-quality clinical cancer registration is needed to ensure comparability of survival across Europe and refine our understanding of the NBL biology.
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Affiliation(s)
- Maria A Karalexi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Marina Servitzoglou
- Department of Pediatric Hematology-Oncology, 'Pan. & Agl. Kyriakou' Children's Hospital
| | - Vassilios Papadakis
- Department of Pediatric Hematology-Oncology, 'Agia Sofia' Children's Hospital, Athens, Greece
| | - Denis Kachanov
- Department of Clinical Oncology, Federal Scientific and Clinical Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russian Federation
| | - Maja Česen Mazič
- Department for Pediatric Hematology and Oncology, University Children Hospital Ljubljana, Ljubljana, Slovenia
| | - Margaret Baka
- Department of Pediatric Hematology-Oncology, 'Pan. & Agl. Kyriakou' Children's Hospital
| | - Maria Moschovi
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, University of Athens, 'Agia Sofia' Children's Hospital, Athens
| | - Maria Kourti
- Department of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki
| | - Sofia Polychronopoulou
- Department of Pediatric Hematology-Oncology, 'Agia Sofia' Children's Hospital, Athens, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, Heraklion
| | - Emmanuel Hatzipantelis
- Hematology-Oncology Unit, 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki
| | - Helen Dana
- Pediatric Hematology-Oncology Department, 'Mitera' Children's Hospital
| | | | - Astero Malama
- Department of Imaging, National and Kapodistrian University of Athens
| | | | | | - Tatyana Shamanskaya
- Department of Clinical Oncology, Federal Scientific and Clinical Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russian Federation
| | - Panagiota Bouka
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Paraskevi Panagopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
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29
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Lee ACW, Chui CH, Kwok R, Lee KS, Fong CM, Wong WHS. Treatment and outcomes of high-risk neuroblastoma in Southeast Asia: a single-institution experience and review of the literature. Singapore Med J 2023; 64:319-325. [PMID: 34688228 PMCID: PMC10219116 DOI: 10.11622/smedj.2021164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In Europe and North America, the majority of children with high-risk neuroblastoma survive the disease. Elsewhere, the treatment outcomes are poor. METHODS A retrospective review of children treated for high-risk neuroblastoma in a single institution in Singapore from 2007 to 2019 was carried out. Treatment consisted of intensive chemotherapy, surgery aimed at gross total resection of residual disease after chemotherapy, consolidation with high-dose therapy followed by autologous stem cell rescue, and radiotherapy to the primary and metastatic sites followed by maintenance treatment with either cis-retinoic acid or anti-disialoganglioside monoclonal antibody therapy. Survival data were examined on certain clinical and laboratory factors. RESULTS There were 57 children (32 male) treated for high-risk neuroblastoma. Their mean age was 3.9 (range 0.7-14.9) years. The median follow-up time was 5.5 (range 1.8-13.0) years for the surviving patients. There were 31 survivors, with 27 patients surviving in first remission, and the five-year overall survival and event-free survival rates were 52.5% and 47.4%, respectively. On log-rank testing, only the group of 17 patients who were exclusively treated at our centre had a survival advantage. Their five-year overall survival rate compared to patients whose initial chemotherapy was done elsewhere was 81.6% versus 41.1% (P = 0.011), and that of event-free survival was 69.7% versus 36.1% (P = 0.032). Published treatment results were obtained from four countries in Southeast Asia with five-year overall survival rates from 13.5% to 28.2%. CONCLUSION Intensified medical and surgical treatment for high-risk neuroblastoma proved to be effective, with superior survival rates compared to previous data from Southeast Asia.
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Affiliation(s)
- Anselm Chi-Wai Lee
- Children’s Haematology and Cancer Centre, Mount Elizabeth Hospital, Singapore
| | - Chan Hon Chui
- Surgery Centre for Children, Mount Elizabeth Medical Centre, Singapore
| | - Robert Kwok
- Radiology Clinic, Mount Elizabeth Hospital, Singapore
| | - Kim Shang Lee
- Radiation Oncology Centre, Mount Elizabeth Hospital, Singapore
| | - Chee Meng Fong
- Parkway Laboratory Services, Mount Elizabeth Hospital, Singapore
| | - Wilfred Hing-Sang Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
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30
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Liu S, Yin W, Lin Y, Huang S, Xue S, Sun G, Wang C. Metastasis pattern and prognosis in children with neuroblastoma. World J Surg Oncol 2023; 21:130. [PMID: 37046344 PMCID: PMC10091559 DOI: 10.1186/s12957-023-03011-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND We aimed to investigate the different metastases and prognoses of neuroblastoma (NB) and determine the risk factors of metastasis. METHOD Data of 1224 patients with NB were obtained from the Surveillance, Epidemiology and End Results database (2010-2018). Pearson's chi-square test, Kaplan-Meier analysis, multivariable logistic regression and Cox regression analysis were used to determine the factors associated with prognosis. RESULTS The overall incidence of NB was an age-adjusted rate of 8.2 patients per 1,000,000 children. In total, 1224 patients were included in our study, with 599 patients (48.9%) exhibiting distant metastases. Compared to patients with non-metastatic NB, a greater proportion of patients with metastatic NB were under 1 year, male, had an adrenal primary site, unilateral tumour, a tumour size > 10 cm, neuroblastoma-not otherwise specified (NB-NOS), second malignant neoplasms and were more likely to choose radiotherapy and chemotherapy. Multivariate Cox regression showed that metastasis was an independent risk factor for overall survival (OS) and cancer-specific survival (CSS). The survival rate of non-metastatic patients with NB was better than those with metastasis (OS: hazard ratio (HR): 0.248, P < 0.001; CSS: HR: 0.267, P < 0.001). The bone and liver were the two most common isolated metastatic sites in NB. However, no statistical difference was observed in OS and CSS between the only bone metastasis group, only liver metastasis group and bone metastasis combined with liver metastasis group (all P > 0.05). Additionally, age at diagnosis > 1 year (odds ratio (OR): 3.295, P < 0 .001), grades III-IV (OR: 26.228, P < 0 .001) and 5-10 cm tumours (OR: 1.781, P < 0 .001) increased the risk of bone metastasis of NB. Moreover, no surgical treatment (OR: 2.441, P < 0 .001) increased the risk of liver metastasis of NB. CONCLUSION Metastatic NB has unique clinicopathological features, with the bone and liver as the most common single metastatic sites of NB. Therefore, more aggressive treatment is recommended for high-risk children with NB displaying distant metastases.
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Affiliation(s)
- Shan Liu
- Department of Hematology-Oncology, Fujian Children's Hospital, Fujian Medical University, Fuzhou, Fujian, China
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Weimin Yin
- Department of Hematology-Oncology, Fujian Children's Hospital, Fujian Medical University, Fuzhou, Fujian, China
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Yaobin Lin
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Sihan Huang
- Department of Hematology-Oncology, Fujian Children's Hospital, Fujian Medical University, Fuzhou, Fujian, China
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Shufang Xue
- Department of Hematology-Oncology, Fujian Children's Hospital, Fujian Medical University, Fuzhou, Fujian, China
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Gaoyuan Sun
- Department of Hematology-Oncology, Fujian Children's Hospital, Fujian Medical University, Fuzhou, Fujian, China
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Chengyi Wang
- Department of Hematology-Oncology, Fujian Children's Hospital, Fujian Medical University, Fuzhou, Fujian, China.
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China.
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31
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Abstract
Neuroblastoma is the most common malignant solid tumor handled by pediatric surgeons. It is well-known that neuroblastoma shows variable biological and clinical behaviors. In this review article, surgical strategy in neuroblastoma was described by risk stratification. Also, strategy of biopsy and clinical conditions that require special considerations such as neuroblastoma detected by mass screening, relapsed neuroblastoma, patients with stage MS and dumbbell type tumors was mentioned. As multimodal systemic treatments have been expanding, the role of surgery in neuroblastoma has become relatively less significant but requisite. We surgeons should decide therapeutic strategy based on the correct understanding of biology of neuroblastoma thinking of the better future of children.
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Affiliation(s)
- Akihiro Yoneda
- Division of Surgery, Department of Surgical Specialties / Division of Surgical Oncology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.
- Division of Pediatric Surgical Oncology, National Cancer Center Hospital, Tokyo, Japan.
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32
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Urla C, Warmann SW, Schmidt A, Mayer B, Handgretinger R, Neunhoeffer F, Schäfer J, Fuchs J. Two-cavities approach for resection of pediatric abdominal neuroblastic tumors: experience of a national reference pediatric onco-surgical center. J Cancer Res Clin Oncol 2023; 149:1485-1493. [PMID: 35522292 PMCID: PMC10020289 DOI: 10.1007/s00432-022-04027-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Surgery of complex neuroblastic tumors often requires additional procedures, especially in the situation of tumor extension within thorax and impossibility of securing the aorta above the tumor. These situations prompt the opening of the thoracic cavity. The concern regarding increased operative trauma and morbidity associated with this approach make surgeons reluctant regarding this technique. The aim of this study was to evaluate the efficacy of two-cavities approach based on our experience in a reference pediatric onco-surgical center. METHODS Between 2003 and 2021, we operated on 232 neuroblastic tumors. 31/232 patients with complex, advanced-stage neuroblastic tumors underwent tumor resection through a two-cavities approach. A retrospective review of patient's records was performed. RESULTS The median age at operation was 48 months (5-180). 23/31 patients presented image-defined risk factors (IDRF). The approach most commonly used was the transverse laparotomy with incision of the diaphragm (n = 14), followed by the thoraco-abdominal incision (n = 10). Gross total resection (GTR) was achieved in 24 patients, a near-GTR in 4 cases, and an incomplete resection in 3 cases. Median duration of surgery was 288 min (99-900) and median duration of mechanical ventilation was 22 h (0-336). Postoperative complications occurred in 10 patients, 6/10 required surgical reintervention. The 5-year overall survival (OS) was 90% and the 5-year event-free survival (EFS) was 50%. CONCLUSIONS The two-cavities approach for resection of abdominal neuroblastoma in children is a safe technique with no added morbidity.
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Affiliation(s)
- Cristian Urla
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Steven W Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Benjamin Mayer
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Rupert Handgretinger
- Department of Pediatric Hematology and Oncology, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Intensive Care, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Jürgen Schäfer
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tübingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
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High-Risk Neuroblastoma: A Surgical Perspective. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020388. [PMID: 36832517 PMCID: PMC9955866 DOI: 10.3390/children10020388] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
High-risk neuroblastoma requires multimodal treatment including systemic chemotherapy, surgical resection, radiation therapy, stem cell transplant, and immunotherapy. Surgeons play a vital role in obtaining local control of neuroblastoma and must therefore be knowledgeable about this complex pathology. This article provides a review of the optimal timing and extent of resection, the impact of various image-defined risk factors on surgical planning, and surgical approaches and techniques to enhance the resection of tumors in different anatomic locations.
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Oh J, Gutkin P, Wang YP, Sandhu N, Majzner RG, Nadel H, Shimada H, Lansinger O, von Eyben R, Donaldson S, Bruzoni M, Sodji QH, Hiniker SM. Time to resolution of iodine-123 metaiodobenzylguanidine ( 123 I-MIBG) avidity and local control outcomes for high-risk neuroblastoma following radiation therapy. J Med Imaging Radiat Oncol 2023; 67:81-88. [PMID: 36300562 DOI: 10.1111/1754-9485.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION 123 I-MIBG scan is used in neuroblastoma (NB) to monitor treatment response. Time to resolution of 123 I-MIBG avidity after radiation therapy (RT) is unknown. We sought to determine time to resolution of 123 I-MIBG avidity after RT and local failure (LF) rate. METHODS We performed a retrospective review of children with high-risk NB who underwent 123 I-MIBG scans pre- and post-RT from 2003 to 2019. Time from RT to resolution of 123 I-MIBG activity was analysed. LF and cumulative incidence of local progression (CILP) after RT stratified by site, presence of residual disease and use of boost RT were determined. RESULTS Forty-two patients with median age 3.9 years (1.9-4.7 years) were included, with median follow-up time 3.9 years (1.4-6.9). Eighty-six lesions were treated with RT to median dose of 21.6 Gy. Eighteen of 86 lesions were evaluable for time to resolution of MIBG avidity after RT, with median resolution time of 78 days (36-208). No LF occurred among 26 patients who received RT to primary sites after GTR, versus 4/12 (25%) patients treated with residual primary disease. 2-year CILP was 19% (12% primary disease 25% metastatic disease (P = 0.18)). 2-year CILP for non-residual primary, residual primary, non-residual metastatic and residual metastatic lesions was 0%, 42%, 11% and 30% respectively (P = 0.01) and for boosted and non-boosted residual lesions was 29% and 35% (P = 0.44). CONCLUSION Median time to MIBG resolution after RT was 78 days. Primary lesions without residual disease had excellent local control. LF rate was higher after RT for residual disease, with no benefit for boost RT.
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Affiliation(s)
- Justin Oh
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Paulina Gutkin
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Yi Peng Wang
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Navjot Sandhu
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Robbie G Majzner
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Helen Nadel
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Hiroyuki Shimada
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Olivia Lansinger
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Sarah Donaldson
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Matias Bruzoni
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Quaovi H Sodji
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
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Pio L, Guérin F, Martucci C, Martelli H, Gauthier F, Branchereau S. The Use of Cavitron Ultrasonic Surgical Aspirator for High-Risk Neuroblastoma with Image-Defined Risk Factors in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010089. [PMID: 36670640 PMCID: PMC9857095 DOI: 10.3390/children10010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023]
Abstract
Aim of the study: The cavitron ultrasonic surgical aspirator (CUSA) has gained popularity in adult surgical oncology, but its application in children is limited to liver surgery and neurosurgical procedures. The complete resection of neuroblastoma with image-defined risk factors (IDRFs) is still considered one of the most difficult procedures to achieve in pediatric surgical oncology, with a high morbidity rate and potential risk of intraoperative mortality. The aim of our study is to describe the application of ultrasonic dissection in neuroblastoma with IDRFs. Methods: A retrospective study was performed, analyzing patients operated on from 2000 to 2018. Patient characteristics, resection completeness, and postoperative surgical and oncology outcomes were analyzed. Main results: Twenty-six patients with high-risk neuroblastoma and IDRFs were operated on in the study period with a CUSA. A complete macroscopic resection was performed in 50% of patients, while the other half was operated on with minimal residual (<5 mL). Six post-operative complications occurred without the need for surgery (Clavien−Dindo < 3). The overall survival was 50%, with a median follow-up of 69.6 months (5.6−140.4). Conclusions: The application of the CUSA in neuroblastoma with IDRFs can be considered an effective and safe alternative technique to achieve a radical resection.
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Affiliation(s)
- Luca Pio
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
- Correspondence:
| | - Florent Guérin
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
| | - Cristina Martucci
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
| | - Helene Martelli
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
| | - Frédéric Gauthier
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
| | - Sophie Branchereau
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
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Clark RA, Jacobson JC, Murphy JT. Preoperative spinal angiography decreases risk of spinal ischemia in pediatric posterior thoracic tumor resection. Pediatr Surg Int 2022; 38:1427-1434. [PMID: 35867126 DOI: 10.1007/s00383-022-05174-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Resection of pediatric posterior thoracic tumors (PTTs) can be complicated by Artery of Adamkiewicz (AKA) injury. Post-op spinal ischemia occurs in approx. 3.2% of patients, typically due to iatrogenic vascular injury. Pre-op angiography (PSA) may help to avoid this complication. Herein, we aim to evaluate outcomes after initiation of routine PSA prior to PTT resection. METHODS A single-institution retrospective review identified 25 children (< 18 years) treated for PTTs from 2009 to 2021. PTTs included: posterior mediastinum, paraspinal thorax and posterior chest wall tumors. PSA patients were compared to those without pre-operative angiography (NA). Demographics, perioperative and long-term outcomes and event-free survival (EFS) were assessed. RESULTS Prior to 2012, eleven patients were treated without PSA. However, the last developed post-operative paraplegia secondary to spinal ischemia. Since this event, PSA has become routine for all PTTs (n = 14) identifying six AKAs and nine accessory spinal arteries. Resection was performed in ten (90.1%) NA patients and eight (57.1%) PSA patients. Based on PSA findings, resection was not offered to six patients and planned partial resection was performed in three patients. Five PSA patients required radiation therapy for local control vs two NA patients. There were no differences in recurrence or overall EFS. CONCLUSION PSA aids in identifying patients with high-risk thoracic vascular anatomy and may prevent risk of post-operative paraplegia associated with PTT resection.
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Affiliation(s)
- Rachael A Clark
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, 1935 Medical District Dr. Suite D2000, Dallas, TX, 75235, USA
| | - Jillian C Jacobson
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, 1935 Medical District Dr. Suite D2000, Dallas, TX, 75235, USA
| | - Joseph T Murphy
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, 1935 Medical District Dr. Suite D2000, Dallas, TX, 75235, USA.
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LaQuaglia MP, Gerstle JT. Advances in the treatment of pediatric solid tumors: A 50-year perspective. J Surg Oncol 2022; 126:933-942. [PMID: 36087080 PMCID: PMC9473291 DOI: 10.1002/jso.27038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 12/17/2022]
Abstract
In the United States, more than 10 000 cancers occur annually in children aged 0-14 years, and more than 5000 in adolescents aged 15-19. In the last 50 years, significant advances have been made in imaging, molecular pathology, stage and risk assessment, surgical approach, multidisciplinary treatment, and survival for pediatric solid tumors (particularly neuroblastoma, Wilms tumor, rhabdomyosarcoma, and hepatoblastoma). Moreover, the molecular driver for fibrolamellar hepatocellular carcinoma, which occurs in adolescence and young adulthood, has been identified.
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Affiliation(s)
- Michael P LaQuaglia
- Pediatric Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Justin T Gerstle
- Pediatric Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Bartolucci D, Montemurro L, Raieli S, Lampis S, Pession A, Hrelia P, Tonelli R. MYCN Impact on High-Risk Neuroblastoma: From Diagnosis and Prognosis to Targeted Treatment. Cancers (Basel) 2022; 14:4421. [PMID: 36139583 PMCID: PMC9496712 DOI: 10.3390/cancers14184421] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Among childhood cancers, neuroblastoma is the most diffuse solid tumor and the deadliest in children. While to date, the pathology has become progressively manageable with a significant increase in 5-year survival for its less aggressive form, high-risk neuroblastoma (HR-NB) remains a major issue with poor outcome and little survivability of patients. The staging system has also been improved to better fit patient needs and to administer therapies in a more focused manner in consideration of pathology features. New and improved therapies have been developed; nevertheless, low efficacy and high toxicity remain a staple feature of current high-risk neuroblastoma treatment. For this reason, more specific procedures are required, and new therapeutic targets are also needed for a precise medicine approach. In this scenario, MYCN is certainly one of the most interesting targets. Indeed, MYCN is one of the most relevant hallmarks of HR-NB, and many studies has been carried out in recent years to discover potent and specific inhibitors to block its activities and any related oncogenic function. N-Myc protein has been considered an undruggable target for a long time. Thus, many new indirect and direct approaches have been discovered and preclinically evaluated for the interaction with MYCN and its pathways; a few of the most promising approaches are nearing clinical application for the investigation in HR-NB.
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Affiliation(s)
| | - Luca Montemurro
- Pediatric Oncology and Hematology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | | | - Andrea Pession
- Pediatric Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Patrizia Hrelia
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Roberto Tonelli
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
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Vo KT, DuBois SG, Neuhaus J, Braunstein SE, Weil BR, Naranjo A, Irtan S, Balaguer J, Matthay KK. Pattern and predictors of sites of relapse in neuroblastoma: A report from the International Neuroblastoma Risk Group (INRG) project. Pediatr Blood Cancer 2022; 69:e29616. [PMID: 35188340 PMCID: PMC9329207 DOI: 10.1002/pbc.29616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE We sought to analyze biologic, clinical, and prognostic differences according to pattern of failure at the time of first relapse in neuroblastoma. PATIENTS AND METHODS Children <21 years diagnosed with neuroblastoma between 1989 and 2017 with known site of first relapse (isolated local vs. distant only vs. combined local and distant sites) were identified from the International Neuroblastoma Risk Group (INRG) database. Data were compared between sites of relapse according to clinical features, biologic features, initial treatment, time to first relapse, and overall survival (OS) from time of first relapse. RESULTS Pattern of first relapse among 1833 children was 19% isolated local; 65% distant only; and 16% combined sites. All evaluated clinical and biologic variables with exception of tumor diagnosis differed statistically by relapse pattern, with patients with isolated local failure having more favorable prognostic features. Patients with stage 3 disease were more likely to have isolated local failure compared to all other stages (49% vs. 16%; p < .001). OS significantly differed by relapse pattern (5-year OS ± SE): isolated local: 64% ± 3%; distant only: 23% ± 2%; and combined: 26% ± 4% (p < .001). After controlling for age, stage, and MYCN status, patients with isolated local failure (adjusted hazard ratio [HR] = 0.46; 95% confidence interval [CI]: 0.33-0.62; p < .001) and distant-only failure (adjusted HR = 0.57; 95% CI: 0.45-0.71; p < .001) remained at decreased risk for death as compared to patients with combined failure. CONCLUSION Patients with distant-only and combined failures have a higher proportion of unfavorable clinical and biological features, and a lower survival than those with isolated local relapse.
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Affiliation(s)
- Kieuhoa T. Vo
- UCSF Benioff Children’s Hospital and Departments of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Steven G. DuBois
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA, USA
| | - John Neuhaus
- Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Steve E. Braunstein
- Radiation Oncology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Brent R. Weil
- Department of Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Arlene Naranjo
- Department of Biostatistics, University of Florida, Children’s Oncology Group Statistics and Data Center, Gainesville, FL, USA
| | - Sabine Irtan
- Department of Pediatric Surgery, Hôpital d’enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Julia Balaguer
- Pediatric Oncology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Katherine K. Matthay
- UCSF Benioff Children’s Hospital and Departments of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
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40
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Desai AV, Applebaum MA, Karrison TG, Oppong A, Yuan C, Berg KR, MacQuarrie K, Sokol E, Hall AG, Pinto N, Wolfe I, Mody R, Shusterman S, Smith V, Foster JH, Nassin M, LaBelle JL, Bagatell R, Cohn SL. Efficacy of post-induction therapy for high-risk neuroblastoma patients with end-induction residual disease. Cancer 2022; 128:2967-2977. [PMID: 35665495 PMCID: PMC10764281 DOI: 10.1002/cncr.34263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND High-risk neuroblastoma patients with end-induction residual disease commonly receive post-induction therapy in an effort to increase survival by improving the response before autologous stem cell transplantation (ASCT). The authors conducted a multicenter, retrospective study to investigate the efficacy of this approach. METHODS Patients diagnosed between 2008 and 2018 without progressive disease with a partial response or worse at end-induction were stratified according to the post-induction treatment: 1) no additional therapy before ASCT (cohort 1), 2) post-induction "bridge" therapy before ASCT (cohort 2), and 3) post-induction therapy without ASCT (cohort 3). χ2 tests were used to compare patient characteristics. Three-year event-free survival (EFS) and overall survival (OS) were estimated by the Kaplan-Meier method and survival curves were compared by log-rank test. RESULTS The study cohort consisted of 201 patients: cohort 1 (n = 123), cohort 2 (n = 51), and cohort 3 (n = 27). Although the end-induction response was better for cohort 1 than cohorts 2 and 3, the outcomes for cohorts 1 and 2 were not significantly different (P = .77 for EFS and P = .85 for OS). Inferior outcomes were observed for cohort 3 (P < .001 for EFS and P = .06 for OS). Among patients with end-induction stable metastatic disease, 3-year EFS was significantly improved for cohort 2 versus cohort 1 (P = .04). Cohort 3 patients with a complete response at metastatic sites after post-induction therapy had significantly better 3-year EFS than those with residual metastatic disease (P = .01). CONCLUSIONS Prospective studies to confirm the benefits of bridge treatment and the prognostic significance of metastatic response observed in this study are warranted.
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Affiliation(s)
- Ami V. Desai
- Department of Pediatrics, University of Chicago, Chicago, IL
| | | | | | - Akosua Oppong
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Cindy Yuan
- Department of Radiology, University of Chicago, Chicago, IL
| | - Katherine R. Berg
- Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA
| | - Kyle MacQuarrie
- Ann and Robert H. Lurie Children’s Hospital of Chicago and Northwestern University, Chicago, IL
| | - Elizabeth Sokol
- Ann and Robert H. Lurie Children’s Hospital of Chicago and Northwestern University, Chicago, IL
| | - Anurekha G. Hall
- Seattle Children’s Hospital and University of Washington, Seattle, WA
| | - Navin Pinto
- Seattle Children’s Hospital and University of Washington, Seattle, WA
| | - Ian Wolfe
- C.S Mott Children’s Hospital and University of Michigan, Ann Arbor, MI
| | - Rajen Mody
- C.S Mott Children’s Hospital and University of Michigan, Ann Arbor, MI
| | - Suzanne Shusterman
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Valeria Smith
- Texas Children’s Hospital and Baylor College of Medicine, Houston, TX
| | | | - Michele Nassin
- Department of Pediatrics, University of Chicago, Chicago, IL
| | | | - Rochelle Bagatell
- Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA
| | - Susan L. Cohn
- Department of Pediatrics, University of Chicago, Chicago, IL
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Abstract
Neuroblastomas are tumours of sympathetic origin, with a heterogeneous clinical course ranging from localized or spontaneously regressing to widely metastatic disease. Neuroblastomas recapitulate many of the features of sympathoadrenal development, which have been directly targeted to improve the survival outcomes in patients with high-risk disease. Over the past few decades, improvements in the 5-year survival of patients with metastatic neuroblastomas, from <20% to >50%, have resulted from clinical trials incorporating high-dose chemotherapy with autologous stem cell transplantation, differentiating agents and immunotherapy with anti-GD2 monoclonal antibodies. The next generation of trials are designed to improve the initial response rates in patients with high-risk neuroblastomas via the addition of immunotherapies, targeted therapies (such as ALK inhibitors) and radiopharmaceuticals to standard induction regimens. Other trials are focused on testing precision medicine strategies for patients with relapsed and/or refractory disease, enhancing the antitumour immune response and improving the effectiveness of maintenance regimens, in order to prolong disease remission. In this Review, we describe advances in delineating the pathogenesis of neuroblastoma and in identifying the drivers of high-risk disease. We then discuss how this knowledge has informed improvements in risk stratification, risk-adapted therapy and the development of novel therapies.
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Affiliation(s)
- Bo Qiu
- Department of Paediatrics, Division of Paediatric Hematology and Oncology, University of California San Francisco, San Francisco, CA, USA.
| | - Katherine K Matthay
- Department of Paediatrics, Division of Paediatric Hematology and Oncology, University of California San Francisco, San Francisco, CA, USA.
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42
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Wei Z, Li J, Jin Y, Liu Y, Wang P, Cao Y, Zhao Q. The application and value of radiotherapy at the primary site in patients with high-risk neuroblastoma. Br J Radiol 2022; 95:20211086. [PMID: 35312349 PMCID: PMC10996409 DOI: 10.1259/bjr.20211086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/22/2022] [Accepted: 03/14/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To retrospectively analyze radiotherapy (RT) regimens for patients with high-risk neuroblastoma (HRNB) at the primary site after surgery, and to further analyze the characteristics of patients who would benefit more from RT. METHODS 98 pediatric patients with HRNB were analyzed for local control (LC), RT dose, extent of excision and prognostic factors. Among them, 69 children received RT. RESULTS The 3 year LC rates were 96.9 and 62.1% (p < 0.001) in the RT and non-RT groups, respectively. In the non-RT group, LC was better in patients with complete macroscopic resection (CME) than in those with incomplete macroscopic resection (IME) (p = 0.026), while in the RT group, no significant difference in LC was found (p = 0.985). Among patients with IME, the LC was 100% in patients with RT doses >= 36 Gy and 66.7% in patients with doses <36 Gy. CONCLUSION RT is valuable, provides patients with excellent LC, and is safe in the short term. RT had a complementary therapeutic effect on incompletely resected tumors, thus bringing their LC to the level of patients with CME. For patients with IME, RT at a dose of not less than 36 Gy may improve LC. ADVANCES IN KNOWLEDGE This study analysed the role of radiotherapy in HRNB, investigated the dose of RT depending on the degree of resection, and explored the characteristics of patients who would benefit more from RT.
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Affiliation(s)
- Zixuan Wei
- Department of Pediatric Oncology, Tianjin Medical University
Cancer Institute and Hospital, National Clinical Research Center for
Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin,
Tianjin’s Clinical Research Center for Cancer,
Tianjin, China
| | - Jie Li
- Department of Pediatric Oncology, Tianjin Medical University
Cancer Institute and Hospital, National Clinical Research Center for
Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin,
Tianjin’s Clinical Research Center for Cancer,
Tianjin, China
| | - Yan Jin
- Department of Pediatric Oncology, Tianjin Medical University
Cancer Institute and Hospital, National Clinical Research Center for
Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin,
Tianjin’s Clinical Research Center for Cancer,
Tianjin, China
| | - Yun Liu
- Department of Pediatric Oncology, Tianjin Medical University
Cancer Institute and Hospital, National Clinical Research Center for
Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin,
Tianjin’s Clinical Research Center for Cancer,
Tianjin, China
| | - Peiguo Wang
- Department of Radiotherapy, Tianjin Medical University Cancer
Institute and Hospital, National Clinical Research Center for Cancer,
Key Laboratory of Cancer Prevention and Therapy of Tianjin,
Tianjin’s Clinical Research Center for Cancer,
Tianjin, China
| | - Yanna Cao
- Department of Pediatric Oncology, Tianjin Medical University
Cancer Institute and Hospital, National Clinical Research Center for
Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin,
Tianjin’s Clinical Research Center for Cancer,
Tianjin, China
| | - Qiang Zhao
- Department of Pediatric Oncology, Tianjin Medical University
Cancer Institute and Hospital, National Clinical Research Center for
Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin,
Tianjin’s Clinical Research Center for Cancer,
Tianjin, China
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43
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DuBois SG, Macy ME, Henderson TO. High-Risk and Relapsed Neuroblastoma: Toward More Cures and Better Outcomes. Am Soc Clin Oncol Educ Book 2022; 42:1-13. [PMID: 35522915 DOI: 10.1200/edbk_349783] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Approximately half of the patients diagnosed with neuroblastoma are classified as having high-risk disease. This group continues to have inadequate cure rates despite multiagent chemotherapy, surgery, high-dose chemotherapy with autologous stem cell rescue, and immunotherapy directed against GD2. We review current efforts to try to improve outcomes in patients with newly diagnosed disease by integrating novel targeted therapies earlier in the course of the disease. We further examine a growing list of options available for patients with relapsed or refractory high-risk disease, with an eye toward graduating successful strategies from a relapsed/refractory setting to the frontline setting. Last, we review efforts to study and potentially mitigate the array of late effects faced by survivors of high-risk neuroblastoma.
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Affiliation(s)
- Steven G DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Margaret E Macy
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Tara O Henderson
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL
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44
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Sundquist F, Georgantzi K, Jarvis KB, Brok J, Koskenvuo M, Rascon J, van Noesel M, Grybäck P, Nilsson J, Braat A, Sundin M, Wessman S, Herold N, Hjorth L, Kogner P, Granberg D, Gaze M, Stenman J. A Phase II Trial of a Personalized, Dose-Intense Administration Schedule of 177Lutetium-DOTATATE in Children With Primary Refractory or Relapsed High-Risk Neuroblastoma-LuDO-N. Front Pediatr 2022; 10:836230. [PMID: 35359899 PMCID: PMC8960300 DOI: 10.3389/fped.2022.836230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/31/2022] [Indexed: 12/16/2022] Open
Abstract
Background Half the children with high-risk neuroblastoma die with widespread metastases. Molecular radiotherapy is an attractive systemic treatment for this relatively radiosensitive tumor. 131I-mIBG is the most widely used form in current use, but is not universally effective. Clinical trials of 177Lutetium DOTATATE have so far had disappointing results, possibly because the administered activity was too low, and the courses were spread over too long a period of time, for a rapidly proliferating tumor. We have devised an alternative administration schedule to overcome these limitations. This involves two high-activity administrations of single agent 177Lu-DOTATATE given 2 weeks apart, prescribed as a personalized whole body radiation absorbed dose, rather than a fixed administered activity. "A phase II trial of 177Lutetium-DOTATATE in children with primary refractory or relapsed high-risk neuroblastoma - LuDO-N" (EudraCT No: 2020-004445-36, ClinicalTrials.gov Identifier: NCT04903899) evaluates this new dosing schedule. Methods The LuDO-N trial is a phase II, open label, multi-center, single arm, two stage design clinical trial. Children aged 18 months to 18 years are eligible. The trial is conducted by the Nordic Society for Pediatric Hematology and Oncology (NOPHO) and it has been endorsed by SIOPEN (https://www.siopen.net). The Karolinska University Hospital, is the sponsor of the LuDO-N trial, which is conducted in collaboration with Advanced Accelerator Applications, a Novartis company. All Scandinavian countries, Lithuania and the Netherlands participate in the trial and the UK has voiced an interest in joining in 2022. Results The pediatric use of the Investigational Medicinal Product (IMP) 177Lu-DOTATATE, as well as non-IMPs SomaKit TOC® (68Ga-DOTATOC) and LysaKare® amino acid solution for renal protection, have been approved for pediatric use, within the LuDO-N Trial by the European Medicines Agency (EMA). The trial is currently recruiting. Recruitment is estimated to be finalized within 3-5 years. Discussion In this paper we present the protocol of the LuDO-N Trial. The rationale and design of the trial are discussed in relation to other ongoing, or planned trials with similar objectives. Further, we discuss the rapid development of targeted radiopharmaceutical therapy and the future perspectives for developing novel therapies for high-risk neuroblastoma and other pediatric solid tumors.
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Affiliation(s)
- Fredrik Sundquist
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kleopatra Georgantzi
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Kirsten Brunsvig Jarvis
- Department of Paediatric Haematology and Oncology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jesper Brok
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Minna Koskenvuo
- Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Jelena Rascon
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Max van Noesel
- Solid Tumor Department, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Per Grybäck
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Joachim Nilsson
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Arthur Braat
- Department of Nuclear Medicine, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Mikael Sundin
- Division of Pediatrics, Department of Pediatric Hematology, Immunology and HCT, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Wessman
- Department of Pathology, Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Nikolas Herold
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skane University Hospital, Lund, Sweden
| | - Per Kogner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Dan Granberg
- Department of Breast, Endocrine Tumors and Sarcomas, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mark Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jakob Stenman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
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Matthyssens LE, Nuchtern JG, Van De Ven CP, Gabra HOS, Bjornland K, Irtan S, Stenman J, Pio L, Cross KM, Avanzini S, Inserra A, Chacon JG, Dall'igna P, Von Schweinitz D, Holmes K, Fuchs J, Squire R, Valteau-Couanet D, Park JR, Eggert A, Losty PD, La Quaglia MP, Sarnacki S. A Novel Standard for Systematic Reporting of Neuroblastoma Surgery: The International Neuroblastoma Surgical Report Form (INSRF): A Joint Initiative by the Pediatric Oncological Cooperative Groups SIOPEN∗, COG∗∗, and GPOH∗∗∗. Ann Surg 2022; 275:e575-e585. [PMID: 32649454 DOI: 10.1097/sla.0000000000003947] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To create the first structured surgical report form for NBL with international consensus, to permit standardized documentation of all NBL-related surgical procedures and their outcomes. SUMMARY OF BACKGROUND DATA NBL, the most common extracranial solid malignant tumor in children, covers a wide spectrum of tumors with significant differences in anatomical localization, organ or vessel involvement, and tumor biology. Complete surgical resection of the primary tumor is an important part of NBL treatment, but maybe hazardous, prone to complications and its role in high-risk disease remains debated. Various surgical guidelines exist within the protocols of the different cooperative groups, although there is no standardized operative report form to document the surgical treatment of NBL. METHODS After analyzing the treatment protocols of the SIOP Europe International Neuroblastoma Study Group, Children's Oncology Group, and Gesellschaft fuer Paediatrische Onkologie und Haematologie - German Association of Pediatric Oncology and Haematology pediatric cooperative groups, important variables were defined to completely describe surgical biopsy and resection of NBL and their outcomes. All variables were discussed within the Surgical Committees of SIOP Europe International Neuroblastoma Study Group, Children's Oncology Group, and Gesellschaft fuer Paediatrische Onkologie und Haematologie - German Association of Pediatric Oncology and Haematology. Thereafter, joint meetings were organized to obtain intercontinental consensus. RESULTS The "International Neuroblastoma Surgical Report Form" provides a structured reporting tool for all NBL surgery, in every anatomical region, documenting all Image Defined Risk Factors and structures involved, with obligatory reporting of intraoperative and 30 day-postoperative complications. CONCLUSION The International Neuroblastoma Surgical Report Form is the first universal form for the structured and uniform reporting of NBL-related surgical procedures and their outcomes, aiming to facilitate the postoperative communication, treatment planning and analysis of surgical treatment of NBL.
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Affiliation(s)
- Lucas E Matthyssens
- Department of Gastrointestinal and Pediatric Surgery, Princess Elisabeth Children's Hospital, Ghent University Hospital, Ghent, Belgium
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Cees P Van De Ven
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Hany O S Gabra
- Department of Pediatric Surgery, The Great North Children Hospital, Newcastle University Teaching Hospitals, Newcastle Upon Tyne, United Kingdom
| | - Kristin Bjornland
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Sabine Irtan
- Department of Pediatric Surgery, Hôpital d'enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Jakob Stenman
- Department of Pediatric Surgery and Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Luca Pio
- Department of Visceral and Urological Pediatric Surgery, Hôpital Universitaire Robert-Debré, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Kate M Cross
- Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | | | | | - Javier Gomez Chacon
- Department of Pediatric Surgery, Hospital Universitario y Politécnico La Fé, Valencia, Spain
| | - Patrizia Dall'igna
- Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Italia
| | - Dietrich Von Schweinitz
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Keith Holmes
- Department of Paediatric Surgery, St George's Hospital, London, United Kingdom
| | - Jorg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Tuebingen, Tuebingen, Germany
| | - Roly Squire
- Department of Paediatric Surgery, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Julie R Park
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Angelika Eggert
- Department of Paediatric Oncology & Hematology, Charité University Medicine Berlin, Germany
| | - Paul D Losty
- Academic Department of Pediatric Surgery, Division of Child Health, Alder Hey Children's Hospital, NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
| | - Michael P La Quaglia
- Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, New York
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Université de Paris, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
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Thomas Lucas J. Risk Factors Associated with Metastatic Site Failure in Patients with High-Risk Neuroblastoma. Clin Transl Radiat Oncol 2022; 34:42-50. [PMID: 35345864 PMCID: PMC8956847 DOI: 10.1016/j.ctro.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022] Open
Abstract
We observed an increased hazard for failure at metastatic sites which remain persistently avid on MIBG following systemic therapy. -Limited response to induction therapy described by Curie and SIOPEN score selects patients at greater risk for poly-metastatic site failure. -The low proportion of metastatic sites treated with radiotherapy precluded definitive testing of its impact on the hazard for metastatic site failure. -Patients who are unable to undergo transplant, and/or have extensive disease at diagnosis (lung metastases) may be poor candidates for consolidative metastatic site directed radiotherapy given the high competing risk of failure at a new metastatic site.
Purpose This retrospective study sought to identify predictors of metastatic site failure (MSF) at new and/or original (present at diagnosis) sites in high-risk neuroblastoma patients. Methods and materials Seventy-six high-risk neuroblastoma patients treated on four institutional prospective trials from 1997 to 2014 with induction chemotherapy, surgery, myeloablative chemotherapy, stem-cell rescue, and were eligible for consolidative primary and metastatic site (MS) radiotherapy were eligible for study inclusion. Computed-tomography and I123 MIBG scans were used to assess disease response and Curie scores at diagnosis, post-induction, post-transplant, and treatment failure. Outcomes were described using the Kaplan–Meier estimator. Cox proportional hazards frailty (cphfR) and CPH regression (CPHr) were used to identify covariates predictive of MSF at a site identified either at diagnosis or later. Results MSF occurred in 42 patients (55%). Consolidative MS RT was applied to 30 MSs in 10 patients. Original-MSF occurred in 146 of 383 (38%) nonirradiated and 18 of 30 (60%) irradiated MSs (p = 0.018). Original- MSF occurred in postinduction MIBG-avid MSs in 68 of 81 (84%) nonirradiated and 12 of 14 (85%) radiated MSs (p = 0.867). The median overall and progression-free survival rates were 61 months (95% CI 42.6Not Reached) and 24.1 months (95% CI 16.538.7), respectively. Multivariate CPHr identified inability to undergo transplant (HR 32.4 95%CI 9.396.8, p < 0.001) and/or maintenance chemotherapy (HR 5.2, 95%CI 1.716.2, p = 0.005), and the presence of lung metastases at diagnosis (HR 4.4 95%CI 1.711.1, p = 0.002) as predictors of new MSF. The new MSF-free survival rate at 3 years was 25% and 87% in patients with and without high-risk factors. Conclusions Incremental improvements in systemic therapy influence the patterns and type of metastatic site failure in neuroblastoma. Persistence of MIBG-avidity following induction chemotherapy and transplant at MSs increased the hazard for MSF.
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de Campos Vieira Abib S, Chui CH, Cox S, Abdelhafeez AH, Fernandez-Pineda I, Elgendy A, Karpelowsky J, Lobos P, Wijnen M, Fuchs J, Hayes A, Gerstle JT. International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines. Ecancermedicalscience 2022; 16:1356. [PMID: 35510137 PMCID: PMC9023308 DOI: 10.3332/ecancer.2022.1356] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Indexed: 12/14/2022] Open
Abstract
Most children with tumors will require one or more surgical interventions as part of the care and treatment, including making a diagnosis, obtaining adequate venous access, performing a surgical resection for solid tumors (with staging and reconstruction), performing procedures for cancer prevention and its late effects, and managing complications of treatment; all with the goal of improving survival and quality of life. It is important for surgeons to adhere to sound pediatric surgical oncology principles, as they are closely associated with improved local control and survival. Unfortunately, there is a significant disparity in survival rates in low and middle income countries, when compared to those from high income countries. The International Society of Paediatric Surgical Oncology (IPSO) is the leading organization that deals with pediatric surgical oncology worldwide. This organization allows experts in the field from around the globe to gather and address the surgical needs of children with cancer. IPSO has been invited to contribute surgical guidance as part of the World Health Organization Initiative for Childhood Cancer. One of our goals is to provide surgical guidance for different scenarios, including those experienced in High- (HICs) and Low- and Middle-Income Countries (LMICs). With this in mind, the following guidelines have been developed by authors from both HICs and LMICs. These have been further validated by experts with the aim of providing evidence-based information for surgeons who care for children with cancer. We hope that this initiative will benefit children worldwide in the best way possible. Simone Abib, IPSO President Justin T Gerstle, IPSO Education Committee Chair Chan Hon Chui, IPSO Secretary.
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Affiliation(s)
- Simone de Campos Vieira Abib
- Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, Rua Pedro de Toledo, 572 - Vila Clementino, São Paulo, SP 04021-001, Brazil
| | - Chan Hon Chui
- Surgery Centre for Children, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, 228510, Singapore
| | - Sharon Cox
- Division of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, St Jude Research Hospital 262 Danny Thomas Place. MS133, Memphis, TN 38105, USA
| | - Israel Fernandez-Pineda
- Department of Pediatric Surgery, Virgen del Rocio Children’s Hospital, Av Manuel Siurot S/NN, Sevilla 41013, Spain
| | - Ahmed Elgendy
- Surgical Oncology Unit, Faculty of Medicine, Tanta University, Elgiesh Street, 31111, Tanta, Gharbeya, Egypt
| | - Jonathan Karpelowsky
- Department of Paediatric Surgery, Children’s Hospital at Westmead, Westmead NSW 2145, Australia
| | - Pablo Lobos
- Pediatric Surgery Division, Hospital Italiano de Buenos Aires, Andrés Lamas 812, Buenos Aires 1406, Argentina
| | - Marc Wijnen
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Huispostnummer KE 01.129.2, Postbus 85090, Utretcht 3508AB, The Netherlands
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University of Tuebingen, Hoppe-Seyler-Str. 3, Tübingen 72076, Germany
| | - Andrea Hayes
- Department of Surgery, Howard University Hospital, 1851 9th Street NW, 4th Floor, Washington, DC 20059, USA
| | - Justin T Gerstle
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Mansfield SA, McCarville MB, Lucas JT, Krasin MJ, Federico SM, Santana VM, Furman WL, Davidoff AM. Impact of Neoadjuvant Chemotherapy on Image-Defined Risk Factors in High-Risk Neuroblastoma. Ann Surg Oncol 2022; 29:661-670. [PMID: 34215956 PMCID: PMC8688258 DOI: 10.1245/s10434-021-10386-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/11/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Image-defined risk factors (IDRFs) are associated with surgical risks in neuroblastoma. We sought to evaluate the impact of neoadjuvant therapy on IDRFs and associated ability to achieve gross total resection (GTR) of locoregional disease in patients with high-risk neuroblastoma. METHODS We retrospectively reviewed charts of patients treated on four consecutive high-risk neuroblastoma protocols over a 20-year period at a single institution. The number of IDRFs at diagnosis and just prior to surgery, and the percent decrease of tumor volume from just prior to surgery to the end of induction were determined. RESULTS Eighty-eight patients were included. There were 438 IDRFs (average 5.0 ± 3.1 per patient) at diagnosis and 198 (average 2.3 ± 1.9 per patient) after neoadjuvant chemotherapy (p < 0.01). A reduction in IDRFs was seen in 81.8% of patients with average decrease of 2.9 ± 2.5 per patient. The average percent reduction in tumor volume was 89.8 ± 18.9% and correlated with the number of IDRFs present after chemotherapy (p < 0.01). Three or fewer IDRFs prior to surgery was associated with the highest odds ratio for > 90% GTR at 9.33 [95% confidence interval 3.14-31.5]. CONCLUSION Neoadjuvant chemotherapy reduced the number of IDRFs in the majority of patients with high-risk neuroblastoma. The number of IDRFs present after neoadjuvant therapy correlated with the extent of resection.
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Affiliation(s)
- Sara A Mansfield
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sara M Federico
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Victor M Santana
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Wayne L Furman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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49
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Pio L, Sarnacki S. Editorial: Innovative approaches in pediatric surgical oncology. Front Pediatr 2022; 10:989822. [PMID: 35989983 PMCID: PMC9386678 DOI: 10.3389/fped.2022.989822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Luca Pio
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, United States.,Learning Planet Institute, Université de Paris, Paris, France
| | - Sabine Sarnacki
- Department of Paediatric Surgery, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
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van Heerden J, Esterhuizen TM, Hendricks M, Poole J, Büchner A, Naidu G, du Plessis J, van Emmenes B, van Zyl A, Mathews E, Kruger M. The Association of Clinical Characteristics and Tumour Markers With Image-Defined Risk Factors in the Management of Neuroblastoma in South Africa. Clin Oncol (R Coll Radiol) 2021; 34:e149-e159. [PMID: 34750056 DOI: 10.1016/j.clon.2021.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/04/2021] [Accepted: 10/22/2021] [Indexed: 12/18/2022]
Abstract
AIMS Image-defined risk factors (IDRFs) in neuroblastoma predict surgical complications and management outcomes. As there is a lack of data regarding the association of IDRFs with clinical and pathological factors, this study evaluated the prognostic value of IDRFs to predict neuroblastoma survival outcomes. MATERIALS AND METHODS This was a retrospective study including 345 patients and reviewed diagnostic imaging for 20 IDRFs, pleural effusions and ascites. The IDRFs were grouped into five 'primary IDRFs' cohorts with vascular encasement, involvement of multiple body compartments, organ infiltration, airway obstruction and intraspinal extension. The association between clinical, histopathological and biological characteristics of neuroblastoma and management was evaluated. RESULTS More patients without IDRFs had operations compared with patients with IDRFs, with a trend towards significance (64.4% versus 35.6%, P = 0.082). Patients with multiple compartment tumour involvement (P = 0.003) and organ infiltration (P < 0.001) had a higher risk of surgical complications. The 5-year overall survival of the group with more than one IDRF was 0.0% and those with pleural effusions or ascites 6.7%, associated with the worst outcome (P = 0.005). The total number of IDRFs was not predictive of the metastatic remission rate (P = 0.585) or overall survival (P = 0.142), with no conclusive association found between IDRF groups and clinical or biological markers. CONCLUSIONS Patients with more than one IDRF had the shortest survival time, whereas those with pleural effusions and ascites at diagnosis had a poor outcome. Standardised reporting of IDRFs is crucial for predicting prognosis.
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Affiliation(s)
- J van Heerden
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa; Paediatric Haematology and Oncology, Department of Paediatrics, Antwerp University Hospital, Antwerp, Belgium.
| | - T M Esterhuizen
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Hendricks
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Paediatric Haematology and Oncology Service, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - J Poole
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - A Büchner
- Paediatric Haematology and Oncology, Department of Paediatrics, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - G Naidu
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - J du Plessis
- Department of Paediatrics, Faculty of Health Sciences, University of the Free State, Division of Paediatric Haematology and Oncology, Universitas Hospital, Bloemfontein, South Africa
| | - B van Emmenes
- Division of Paediatric Haematology and Oncology Hospital, Department of Paediatrics, Frere Hospital, East London, South Africa
| | - A van Zyl
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - E Mathews
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Port Elizabeth Provincial Hospital, Walter Sisulu University, Port Elizabeth, South Africa
| | - M Kruger
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
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