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Bleeker L, Kouwenhoven MCM, de Heer I, Lissenberg-Witte BI, Gijsbers AH, Dubbink HJ, Kros JM, Gijtenbeek JMM, Kurt E, van der Rijt CCD, Swaak-Kragten AT, de Vos FY, van der Weide HL, French PJ, van den Bent MJ, Wesseling P, Bromberg JEC. Medulloblastoma in adults: evaluation of the Dutch society for neuro-oncology treatment protocol. J Neurooncol 2023; 162:225-235. [PMID: 36920679 PMCID: PMC10050065 DOI: 10.1007/s11060-023-04285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Medulloblastoma is a rare tumor in adults. The objective of this nationwide, multicenter study was to evaluate the toxicity and efficacy of the Dutch treatment protocol for adult medulloblastoma patients. METHODS Adult medulloblastoma patients diagnosed between 2010 and 2018 were identified in the Dutch rare tumors registry or nationwide pathology database. Patients with intention to treat according to the national treatment protocol were included. Risk stratification was performed based on residual disease, histological subtype and extent of disease. All patients received postoperative radiotherapy [craniospinal axis 36 Gy/fossa posterior boost 19.8 Gy (14.4 Gy in case of metastases)]. High-risk patients received additional neoadjuvant (carboplatin-etoposide), concomitant (vincristine) and adjuvant chemotherapy (carboplatin-vincristine-cyclophosphamide) as far as feasible by toxicity. Methylation profiling, and additional next-generation sequencing in case of SHH-activated medulloblastomas, were performed. RESULTS Forty-seven medulloblastoma patients were identified, of whom 32 were treated according to the protocol. Clinical information and tumor material was available for 28 and 20 patients, respectively. The histological variants were mainly classic (43%) and desmoplastic medulloblastoma (36%). Sixteen patients (57%) were considered standard-risk and 60% were SHH-activated medulloblastomas. Considerable treatment reductions and delays in treatment occurred due to especially hematological and neurotoxicity. Only one high-risk patient could complete all chemotherapy courses. 5-years progression-free survival (PFS) and overall survival (OS) for standard-risk patients appeared worse than for high-risk patients (PFS 69% vs. 90%, OS 81% vs. 90% respectively), although this wasn't statistically significant. CONCLUSION Combined chemo-radiotherapy is a toxic regimen for adult medulloblastoma patients that may result in improved survival.
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Affiliation(s)
- L Bleeker
- Brain Tumor Center Amsterdam, Department of Neurology, Amsterdam UMC, Amsterdam, The Netherlands.
| | - M C M Kouwenhoven
- Brain Tumor Center Amsterdam, Department of Neurology, Amsterdam UMC, Amsterdam, The Netherlands
| | - I de Heer
- Brain Tumor Center, Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - B I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
| | - A H Gijsbers
- The Nationwide Network and Registry of Histopathology and Cytopathology in the Netherlands (PALGA), Houten, The Netherlands
| | - H J Dubbink
- Brain Tumor Center, Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - J M Kros
- Brain Tumor Center, Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - J M M Gijtenbeek
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - E Kurt
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - C C D van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - A T Swaak-Kragten
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - F Y de Vos
- Cancer Center, Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H L van der Weide
- University Medical Center Groningen, Department of Radiation Oncology, University of Groningen, Groningen, The Netherlands
| | - P J French
- Brain Tumor Center, Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M J van den Bent
- Brain Tumor Center, Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - P Wesseling
- Department of Pathology, Amsterdam University Medical Centers/VUmc, Amsterdam, The Netherlands
- Laboratory for Childhood Cancer Pathology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J E C Bromberg
- Brain Tumor Center, Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Henselmans I, Smets EMA, de Haes JCJM, Dijkgraaf MGW, de Vos FY, van Laarhoven HWM. A randomized controlled trial of a skills training for oncologists and a communication aid for patients to stimulate shared decision making about palliative systemic treatment (CHOICE): study protocol. BMC Cancer 2018; 18:55. [PMID: 29310605 PMCID: PMC5759304 DOI: 10.1186/s12885-017-3838-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 11/23/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Systemic treatment for advanced cancer offers uncertain and sometimes little benefit while the burden can be high. Hence, treatment decisions require Shared Decision Making (SDM). The CHOICE trial examines the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment. METHODS A RCT design with four parallel arms will be adopted. Patients with metastatic or irresectable cancer with a median life expectancy <12 months who meet with a medical oncologist to discuss the start or continuation of palliative systemic treatment are eligible. A total of 24 oncologists (in training) and 192 patients will be recruited. The oncologist training consists of a reader, two group sessions (3.5 h; including modelling videos and role play), a booster feedback session (1 h) and a consultation room tool. The patient communication aid consists of a home-sent question prompt list and a value clarification exercise to prepare patients for SDM in the consultation. The control condition consists of care as usual. The primary outcome is observed SDM in audio-recorded consultations. Secondary outcomes include patient and oncologist evaluation of communication and decision-making, the decision made, quality of life, potential adverse outcomes such as anxiety and hopelessness, and consultation duration. Patients fill out questionnaires at baseline (T0), before (T1) and after the consultation (T2) and at 3 and 6 months (T3 and T4). All oncologists participate in two standardized patient assessments (before-after training) prior to the start of patient inclusion. They will fill out a questionnaire before and after these assessments, as well as after each of the recorded consultations in clinical practice. DISCUSSION The CHOICE trial will enable evidence-based choices regarding the investment in SDM interventions targeting either oncologists, patients or both in the advanced cancer setting. The trial takes into account the immediate effect of the interventions on observed communication, but also on more distal and potential adverse patient outcomes. Also, the trial provides evidence regarding the assumption that SDM about palliative cancer treatment results in less aggressive treatment and more quality of life in the final period of life. TRIAL REGISTRATION Netherlands Trial Registry number NTR5489 (prospective; 15 Sep 2015).
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Affiliation(s)
- I. Henselmans
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - E. M. A. Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - J. C. J. M. de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - M. G. W. Dijkgraaf
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - F. Y. de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H. W. M. van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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