2
|
Sabel M, Fleischhack G, Tippelt S, Gustafsson G, Doz F, Kortmann R, Massimino M, Navajas A, von Hoff K, Rutkowski S, Warmuth-Metz M, Clifford SC, Pietsch T, Pizer B, Lannering B; SIOP-E Brain Tumour Group. Relapse patterns and outcome after relapse in standard risk medulloblastoma: a report from the HIT-SIOP-PNET4 study. J Neurooncol 2016; 129:515-24. [PMID: 27423645 DOI: 10.1007/s11060-016-2202-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/03/2016] [Indexed: 12/20/2022]
Abstract
The HIT-SIOP-PNET4 randomised trial for standard risk medulloblastoma (MB) (2001–2006) included 338 patients and compared hyperfractionated and conventional radiotherapy. We here report the long-term outcome after a median follow up of 7.8 years, including detailed information on relapse and the treatment of relapse. Data were extracted from the HIT Group Relapsed MB database and by way of a specific case report form. The event-free and overall (OS) survival at 10 years were 76 ± 2 % and 78 ± 2 % respectively with no significant difference between the treatment arms. Seventy-two relapses and three second malignant neoplasms were reported. Thirteen relapses (18 %) were isolated local relapses in the posterior fossa (PF) and 59 (82 %) were craniospinal, metastatic relapses (isolated or multiple) with or without concurrent PF disease. Isolated PF relapse vs all other relapses occurred at mean/median of 38/35 and 28/26 months respectively (p = 0.24). Late relapse, i.e. >5 years from diagnosis, occurred in six patients (8 %). Relapse treatment consisted of combinations of surgery (25 %), focal radiotherapy (RT 22 %), high dose chemotherapy with stem cell rescue (HDSCR 21 %) and conventional chemotherapy (90 %). OS at 5 years after relapse was 6.0 ± 4 %. In multivariate analysis; isolated relapse in PF, and surgery were significantly associated with prolonged survival whereas RT and HDSCR were not. Survival after relapse was not related to biological factors and was very poor despite several patients receiving intensive treatments. Exploration of new drugs is warranted, preferably based on tumour biology from biopsy of the relapsed tumour.
Collapse
|
3
|
Horwitz M, Dufour C, Leblond P, Bourdeaut F, Faure-Conter C, Bertozzi AI, Delisle MB, Palenzuela G, Jouvet A, Scavarda D, Vinchon M, Padovani L, Gaudart J, Branger DF, Andre N. Embryonal tumors with multilayered rosettes in children: the SFCE experience. Childs Nerv Syst 2016; 32:299-305. [PMID: 26438544 DOI: 10.1007/s00381-015-2920-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSES The purpose of this study was to retrospectively study embryonal tumors with multilayered rosettes (ETMR), a rare new entity that gathers ETAN-TR (embryonal tumor with abundant neuropil and true rosettes), ependymoblastomas, and medulloepitheliomas, in order to improve their descriptions and try to better define therapeutic modalities. METHODS Patients with ETMR, ETAN-TR, ependymoblastoma, and medulloepithelioma treated in SFCE centres (Société Française de lutte contre les Cancers et les leucémies de l'Enfant et de l'adolescent) since 2000 were collected. Data were retrieved from clinical charts. RESULTS Thirty-eight patients were included in the analysis. Seventeen had an ETAN-TR, 13 had a medulloepithelioma, and 8 had an ETMR. No ependymoblastoma was included. The median age at diagnosis was 31 months (range, 2.8-141 months). The predominant tumor location was supratentorial (66%); 18.4% patients had metastatic lesion. LIN28A expression was positive in 11/11 patients. Amplification of the locus 19q13.42 was positive in 10/12 patients. Thirty patients were treated according to the primitive neuroectodermal tumors of high risk (PNET-HR) protocol. The median time of follow-up was 0.9 years (range 0.1 to 15.3 years). The 1-year event-free survival (EFS) and overall survival (OS) were, respectively, 36% CI 95% (23-55) and 45% CI 95% (31-64). On multivariate analysis, complete surgical resection, radiotherapy, and high-dose chemotherapy were associated with a better overall survival with a relative risk of, respectively, 7.9 CI 95% (2.6-23.5) p < 0.0002, 41.8 CI 95% (9.4-186) p < 0.0001, and 3.5 CI 95% (1.3-9.5) p = 0.012. CONCLUSION Prognosis of ETMR remains dismal despite multimodal therapy. LIN28A immunostaining and 19q13.42 amplification should be systematically done to secure the diagnosis. Complete surgical resection, radiotherapy, and high-dose chemotherapy are associated with better outcome.
Collapse
Affiliation(s)
- Meryl Horwitz
- Department of Pediatric Hematology-Oncology, APHM, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France.
| | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Campus, 114, rue Edouard-Vaillant, 94805, Villejuif Cedex, France.
| | - Pierre Leblond
- Department of Pediatric Oncology, Oscar Lambret, 3 rue Frederic Combemale, BP 307, 59020, Lille Cedex, France.
| | - Franck Bourdeaut
- Department of Pediatric Oncology, Institut Curie, 26, rue d'Ulm, 75005, Paris, France. .,INSERM U830, Laboratory of Genetics and Cancer Biology, Institut Curie, Paris, France.
| | - Cécile Faure-Conter
- Department of Pediatrics, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France.
| | - Anne-Isabelle Bertozzi
- Department of Hematology-Oncology, Children University Hospital, 330 Avenue de Grande Bretagne, 31300, Toulouse, France.
| | - Marie Bernadette Delisle
- Department of Neuropathology, Toulouse Rangueil University Hospital, 1, avenue du Pr Jean Poulhès, 31400, Toulouse, France.
| | - Gilles Palenzuela
- Department of Pediatric Hematology-Oncology, University Hospital of Montpellier, 191, avenue du doyen Gaston Giraud, 34295, Montpellier cedex, France.
| | - Anne Jouvet
- Department of Pathology and neuropathology, "Pierre Werthmeier" Hospital, Boulevard Pinel, 69677, Bron, France.
| | - Didier Scavarda
- Department of Neurosurgery, APHM, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France.
| | - Matthieu Vinchon
- Department of Pediatric Neurosurgery, Lille University Hospital, 2 Avenue Oscar Lambret, 59000, Lille, France.
| | - Laetitia Padovani
- Department of Radiation Oncology and Pediatrics, APHM, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France.
| | - Jean Gaudart
- BIOSTIC, Pôle de Santé Publique, AP-HM, Marseille, 264 rue Saint-Pierre, 13005, Marseille, France. .,UMR912 SESSTIM, Aix-Marseille University, Marseille, France.
| | - Dominique Figarella Branger
- Department of Pathology, APHM, La Timone Hospital, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France.
| | - Nicolas Andre
- Department of Pediatric Hematology-Oncology, APHM, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France. .,INSERM UMR 911, Centre de Recherche en Oncologie biologique et en Oncopharmacologie, Aix-Marseille University, 264 rue Saint-Pierre, 13005, Marseille, France. .,Department of Pediatric Hematology and Oncology, Children Hospital of La Timone, 264, rue Saint-Pierre, 13005, Marseille, France.
| |
Collapse
|