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Chisholm J, Mandeville H, Adams M, Minard-Collin V, Rogers T, Kelsey A, Shipley J, van Rijn RR, de Vries I, van Ewijk R, de Keizer B, Gatz SA, Casanova M, Hjalgrim LL, Firth C, Wheatley K, Kearns P, Liu W, Kirkham A, Rees H, Bisogno G, Wasti A, Wakeling S, Heenen D, Tweddle DA, Merks JHM, Jenney M. Frontline and Relapsed Rhabdomyosarcoma (FAR-RMS) Clinical Trial: A Report from the European Paediatric Soft Tissue Sarcoma Study Group (EpSSG). Cancers (Basel) 2024; 16:998. [PMID: 38473359 DOI: 10.3390/cancers16050998] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
The Frontline and Relapsed Rhabdomyosarcoma (FaR-RMS) clinical trial is an overarching, multinational study for children and adults with rhabdomyosarcoma (RMS). The trial, developed by the European Soft Tissue Sarcoma Study Group (EpSSG), incorporates multiple different research questions within a multistage design with a focus on (i) novel regimens for poor prognostic subgroups, (ii) optimal duration of maintenance chemotherapy, and (iii) optimal use of radiotherapy for local control and widespread metastatic disease. Additional sub-studies focusing on biological risk stratification, use of imaging modalities, including [18F]FDG PET-CT and diffusion-weighted MRI imaging (DWI) as prognostic markers, and impact of therapy on quality of life are described. This paper forms part of a Special Issue on rhabdomyosarcoma and outlines the study background, rationale for randomisations and sub-studies, design, and plans for utilisation and dissemination of results.
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Affiliation(s)
- Julia Chisholm
- Children and Young People's Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton SM2 5PT, UK
| | - Henry Mandeville
- Children and Young People's Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton SM2 5PT, UK
| | | | | | - Timothy Rogers
- Department of Paediatric Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Anna Kelsey
- Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Janet Shipley
- The Institute of Cancer Research, London SW7 3RP, UK
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
| | - Isabelle de Vries
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Bart de Keizer
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Susanne A Gatz
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham B15 2TG, UK
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | | | | | - Charlotte Firth
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Wenyu Liu
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Amanda Kirkham
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Helen Rees
- Department of Paediatric Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Gianni Bisogno
- Department of Women and Children's Health, University of Padova, 35122 Padua, Italy
| | - Ajla Wasti
- The Institute of Cancer Research, London SW7 3RP, UK
| | | | | | - Deborah A Tweddle
- Vivo Biobank, Translational & Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Johannes H M Merks
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
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Janssens GO, Timmermann B, Laprie A, Mandeville H, Padovani L, Chargari C, Kearns P, Kozhaeva O, Kameric L, Kienesberger A, van Rossum PSN, Boterberg T, Lievens Y, Vassal G. The organization of care in pediatric radiotherapy across SIOP Europe affiliated centers: A multicenter survey in the framework of the 'Joint Action on Rare Cancers' project. Radiother Oncol 2024; 191:110075. [PMID: 38159681 DOI: 10.1016/j.radonc.2023.110075] [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: 11/06/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND/PURPOSE To reduce inequalities among SIOPE-affiliated countries, standard and optional levels to deliver 'Good Clinical Practice' compliant treatment in pediatric radiation oncology have been published. The aim of this project was to map the availability of pediatric radiotherapy resources across SIOPE-affiliated radiotherapy departments. MATERIALS/METHODS An online survey with 34 questions was distributed to 246 radiotherapy departments across 35 SIOPE-affiliated countries. In addition to demographic data, 15 general items related to the organization of the radiotherapy process, and 10 radiotherapy-specific items were defined. For each of the 25 items, sum scores were calculated per center and country. Mann-Whitney U tests were used to analyze associations. RESULTS Between March-June 2019, 121 departments (49 %) out of 31 countries (89 %) completed the survey. At center level, involvement of core disciplines in tumor boards (28 %), and integration of dedicated pediatric radiation therapy technologists (24 %) are limited, while rare & complex brachytherapy procedures are performed in many centers (23 %). For general and radiotherapy-specific items respectively, a relevant variation of sum scores was observed across countries (Δgeneral: ≤10 points; ΔRT_specific: ≤5 points) and among centers within a country (Δgeneral: ≤9 points; ΔRT_specific: ≤6 points). Sum scores for general and radiotherapy-specific items were higher in countries with a high-income (p < 0.01) and higher health development index (p < 0.01). A larger annual number of irradiated pediatric patients was associated with higher sum scores for general items (p < 0.01). CONCLUSION This survey demonstrates the disparities in organization of pediatric radiotherapy departments between SIOPE-affiliated countries and centers within the same country. Investment is needed to reduce inequalities in pediatric radiotherapy care.
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Affiliation(s)
- Geert O Janssens
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Germany
| | - Anne Laprie
- Department of Radiation Oncology, Oncopole Claudius Regaud at Institut Universitaire du Cancer de Toulouse IUCT-Oncopole, Toulouse, France
| | - Henry Mandeville
- The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Laetitia Padovani
- Aix-Marseille University, Oncology-Radiotherapy-Department, CRCM Inserm UMR1068, CNRSUMR7258 AMUUM105, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, B15 2TT, Birmingham, United Kingdom
| | - Olga Kozhaeva
- Policy Department, European Society for Pediatric Oncology, SIOP Europe, Brussels, Belgium
| | - Leila Kameric
- Childhood Cancer International - Europe, Vienna, Austria
| | | | - Peter S N van Rossum
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Particle Therapy Interuniversity Center Leuven (PARTICLE), Leuven, Belgium
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Gilles Vassal
- Department of Children and Adolescent Oncology, Gustave Roussy Comprehensive Cancer Center, Paris-Saclay University, Villejuif, France
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3
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Davey A, Pan S, Bryce-Atkinson A, Mandeville H, Janssens GO, Kelly SM, Hol M, Tang V, Davies LSC, SIOP-Europe Radiation Oncology Working Group, Aznar M. The need for consensus on delineation and dose constraints of dentofacial structures in paediatric radiotherapy: Outcomes of a SIOP Europe survey. Clin Transl Radiat Oncol 2023; 43:100681. [PMID: 37790584 PMCID: PMC10543782 DOI: 10.1016/j.ctro.2023.100681] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
Background and purpose Children receiving radiotherapy for head-and-neck tumours often experience severe dentofacial side effects. Despite this, recommendations for contouring and dose constraints to dentofacial structures are lacking in clinical practice. We report on a survey aiming to understand current practice in contouring and dose assessment to dentofacial structures. Methods A digital survey was distributed to European Society for Paediatric Oncology members of the Radiation Oncology Working Group, and member-affiliated centres in Europe, Australia, and New Zealand. The questions focused on clinical practice and aimed to establish areas for future development. Results Results from 52 paediatric radiotherapy centres across 27 countries are reported. Only 29/52 centres routinely delineated some dentofacial structures, with the most common being the mandible (25 centres), temporo-mandibular joint (22), dentition (13), orbit (10) and maxillary bone (eight). For most bones contoured, an 'As Low As Reasonably Achievable' dose objective was implemented. Only four centres reported age-adapted dose constraints.The largest barrier to clinical implementation of dose constraints was firstly, the lack of contouring guidance (49/52, 94%) and secondly, that delineation is time-consuming (33/52, 63%). Most respondents who routinely contour dentofacial structures (25/27, 90%) agreed a contouring atlas would aid delineation. Conclusion Routine delineation of dentofacial structures is infrequent in paediatric radiotherapy. Based on survey findings, we aim to 1) define a consensus-contouring atlas for dentofacial structures, 2) develop auto-contouring solutions for dentofacial structures to aid clinical implementation, and 3) carry out treatment planning studies to investigate the importance of delineation of these structures for planning optimisation.
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Affiliation(s)
- Angela Davey
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Shermaine Pan
- Department of Proton Therapy, The Christie NHS Foundation Trust, Manchester, UK
| | - Abigail Bryce-Atkinson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Geert O. Janssens
- Princess Maxima Center for Paediatric Oncology, Utrecht, The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sarah M. Kelly
- European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, Brussels, Belgium
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marinka Hol
- Princess Maxima Center for Paediatric Oncology, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vivian Tang
- Paediatric Radiology, Royal Manchester Children’s Hospital, Manchester, UK
| | | | | | - Marianne Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Mironova D, Benjamin P, Zacharoulis S, Stapleton S, Bridges LR, Jacques TS, Mandeville H, Carceller F. Cortical laminar necrosis mimicking leptomeningeal recurrence in a child with medulloblastoma and epilepsy. Pediatr Blood Cancer 2023; 70:e30641. [PMID: 37644658 DOI: 10.1002/pbc.30641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Denitza Mironova
- Children & Young People's Unit, Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | - Philip Benjamin
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
- Department of Radiology, St George's Hospital, London, UK
| | - Stergios Zacharoulis
- Children & Young People's Unit, Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
- Department of Pediatrics, Irving Medical Center, Columbia University, New York, USA
- Department of Pediatric Oncology, Bristol Myers Squibb, New York, USA
| | - Simon Stapleton
- Department of Neurosurgery, St George's Hospital, London, UK
| | - Leslie R Bridges
- Department of Cellular Pathology, St George's Hospital, London, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Henry Mandeville
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Fernando Carceller
- Children & Young People's Unit, Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
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5
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Hol MLF, Indelicato DJ, Slater O, Kolb F, Hewitt RJ, Ong J, Becking AG, Gains J, Bradley J, Sandler E, Gaze MN, Pieters B, Mandeville H, Fajardo RD, Schoot R, Merks JHM, Hammond P, Smeele LE, Suttie M. Facial deformation following treatment for pediatric head and neck rhabdomyosarcoma; the difference between treatment modalities. Results of a trans-Atlantic, multicenter cross-sectional cohort study. Pediatr Blood Cancer 2023; 70:e30412. [PMID: 37249325 DOI: 10.1002/pbc.30412] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The four different local therapy strategies used for head and neck rhabdomyosarcoma (HNRMS) include proton therapy (PT), photon therapy (RT), surgery with radiotherapy (Paris-method), and surgery with brachytherapy (AMORE). Local control and survival is comparable; however, the impact of these different treatments on facial deformation is still poorly understood. This study aims to quantify facial deformation and investigates the differences in facial deformation between treatment modalities. METHODS Across four European and North American institutions, HNRMS survivors treated between 1990 and 2017, more than 2 years post treatment, had a 3D photograph taken. Using dense surface modeling, we computed facial signatures for each survivor to show facial deformation relative to 35 age-sex-ethnicity-matched controls. Additionally, we computed individual facial asymmetry. FINDINGS A total of 173 HNRMS survivors were included, survivors showed significantly reduced facial growth (p < .001) compared to healthy controls. Partitioned by tumor site, there was reduced facial growth in survivors with nonparameningeal primaries (p = .002), and parameningeal primaries (p ≤.001), but not for orbital primaries (p = .080) All patients were significantly more asymmetric than healthy controls, independent of treatment modality (p ≤ .001). There was significantly more facial deformation in orbital patients when comparing RT to AMORE (p = .046). In survivors with a parameningeal tumor, there was significantly less facial deformation in PT when compared to RT (p = .009) and Paris-method (p = .007). INTERPRETATION When selecting optimal treatment, musculoskeletal facial outcomes are an expected difference between treatment options. These anticipated differences are currently based on clinicians' bias, expertise, and experience. These data supplement clinician judgment with an objective analysis highlighting the impact of patient age and tumor site between existing treatment options.
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Affiliation(s)
- Marinka L F Hol
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University of Utrecht, Utrecht, The Netherlands
- Department of Maxillofacial Surgery, Amsterdam UMC, Duivendrecht, The Netherlands
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | - Olga Slater
- Department of Pediatric Oncology, Great Ormond Street Hospital, NHS Foundation Trust, London, UK
| | - Frederic Kolb
- Department of Plastic Surgery, Institute Gustave Roussy, Paris, France
| | - Richard J Hewitt
- Department of Head & Neck and Tracheal Surgery Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Juling Ong
- Department of Craniofacial, Plastic and Reconstructive Surgery, Chelsea and Westminster NHS Hospital Foundation Trust, London, UK
| | - Alfred G Becking
- Department of Maxillofacial Surgery, Amsterdam UMC, Duivendrecht, The Netherlands
| | - Jenny Gains
- Department of Radiation Oncology, NHS Trust, London, UK
| | - Julie Bradley
- Department of Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | - Eric Sandler
- Division of Pediatric Oncology, Nemours Children's Specialty Clinic, Jacksonville, Florida, USA
| | - Mark N Gaze
- Department of Radiation Oncology, NHS Trust, London, UK
| | - Bradley Pieters
- Department or Radiation Oncology, Amsterdam UMC, Duivendrecht, The Netherlands
| | - Henry Mandeville
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, and Institute of Cancer Research, Sutton, UK
| | | | - Reineke Schoot
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Ludwig E Smeele
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Maxillofacial Surgery, Amsterdam UMC, Duivendrecht, The Netherlands
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6
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Kelly SM, Turcas A, Corning C, Bailey S, Cañete A, Clementel E, di Cataldo A, Dieckmann K, Gaze MN, Horan G, Jenney M, Ladenstein R, Padovani L, Valteau-Couanet D, Boterberg T, Mandeville H. Radiotherapy quality assurance in paediatric clinical trials: first report from six QUARTET-affiliated trials. Radiother Oncol 2023; 182:109549. [PMID: 36828140 DOI: 10.1016/j.radonc.2023.109549] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/30/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND PURPOSE SIOP Europe's QUARTET project launched in 2016; aiming to improve access to high-quality radiotherapy for children and adolescents treated within clinical trials across Europe. The aim of this report is to present the profile of institutions participating in six QUARTET-affiliated trials and a description of the initial individual case review (ICR) outcomes. METHODS This is a two-part analysis. Firstly, using facility questionnaires, beam output audit certificates, and advanced technique credentialing records to create a profile of approved institutions, and secondly, collating trial records for ICRs submitted prior to 31/10/2022. Trials included are: SIOPEN HR-NBL1, SIOPEN-LINES, SIOPEN- VERITAS, SIOP-BTG HRMB, EpSSG-FaR-RMS, and SIOPEN HR-NBL2. RESULTS By 31/10/2022, a total of 103 institutions had commenced QUARTET site approval procedures to participate in QUARTET-affiliated trials; 66 sites across 20 countries were approved. These participating institutions were often paediatric referral sites with intensity modulated radiotherapy or proton beam therapy, designated paediatric radiation oncologists, and paediatric adapted facilities and imaging protocols available. In total, 263 patient plans were submitted for ICR, 254 ICRs from 15 countries were completed. ICRs had a rejection rate of 39.8%, taking an average of 1.4 submissions until approval was achieved. Target delineation was the most frequent reason for rejection. CONCLUSION The QUARTET facility questionnaire is a valuable tool for mapping resources, personnel, and technology available to children and adolescents receiving radiotherapy. Prospective ICR is essential for paediatric oncology clinical trials and should be prioritised to reduce protocol violations.
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Affiliation(s)
- Sarah M Kelly
- The European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, Brussels, Belgium; European Organisation for the Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Andrada Turcas
- The European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, Brussels, Belgium; European Organisation for the Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Department of Oncology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania
| | - Coreen Corning
- European Organisation for the Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Simon Bailey
- Newcastle Cancer Centre, Newcastle University and Great North Children's Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Adela Cañete
- Pediatric Oncohematology Unit, University and Polytechnic la Fe Hospital, Department of Pediatrics, University of Valencia, Spain
| | - Enrico Clementel
- European Organisation for the Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Andrea di Cataldo
- Department of Clinical and Experimental Medicine, Unit of Pediatric Hematology and Oncology, University of Catania, Catania, Italy
| | - Karin Dieckmann
- Children's Cancer Research Institute, St Anna Children's Hospital, Vienna, Austria; Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Gail Horan
- Oncology Centre, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Meriel Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
| | - Ruth Ladenstein
- Children's Cancer Research Institute, St Anna Children's Hospital, Vienna, Austria
| | - Laetitia Padovani
- Department of Radiation Oncology, Assistance Publique Hôpitaux de Marseille, France
| | | | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Henry Mandeville
- The European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, Brussels, Belgium; The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
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7
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Bisogno G, Minard-Colin V, Zanetti I, Ferrari A, Gallego S, Dávila Fajardo R, Mandeville H, Kelsey A, Alaggio R, Orbach D, Terwisscha van Scheltinga S, Guillén Burrieza G, Ben-Arush M, Glosli H, Mudry P, Ferman S, Devalck C, Defachelles AS, Merks JHM, Jenney M. Nonmetastatic Rhabdomyosarcoma in Children and Adolescents: Overall Results of the European Pediatric Soft Tissue Sarcoma Study Group RMS2005 Study. J Clin Oncol 2023; 41:2342-2349. [PMID: 36848614 DOI: 10.1200/jco.22.02093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The RMS2005 study included two phase III randomized trials for high-risk (HR) and observational trials for low (LR), standard (SR), and very high-risk (VHR) patients who have been partially reported. Herein, we present a comprehensive report of results achieved for the complete unselected nonmetastatic cohort and analyze the evolution of treatment in comparison with previous European protocols. After a median follow-up of 73.1 months, the 5-year event-free survival (EFS) and overall survival (OS) of the 1,733 patients enrolled were 70.7% (95% CI, 68.5 to 72.8) and 80.4% (95% CI, 78.4 to 82.3), respectively. The results by subgroup: LR (80 patients) EFS 93.7% (95% CI, 85.5 to 97.3), OS 96.7% (95% CI, 87.2 to 99.2); SR (652 patients) EFS 77.4% (95% CI, 73.9 to 80.5), OS 90.6% (95% CI, 87.9 to 92.7); HR (851 patients) EFS 67.3% (95% CI, 64.0 to 70.4), OS 76.7% (95% CI, 73.6 to 79.4); and VHR (150 patients) EFS 48.8% (95% CI, 40.4 to 56.7), OS 49.7% (95% CI, 40.8 to 57.9). The RMS2005 study demonstrated that 80% of children with localized rhabdomyosarcoma could be long-term survivors. The study has established the standard of care across the European pediatric Soft tissue sarcoma Study Group countries with the confirmation of a 22-week vincristine/actinomycin D regimen for LR patients, the reduction of the cumulative ifosfamide dose in the SR group, and for HR disease, the omission of doxorubicin and the addition of maintenance chemotherapy.
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Affiliation(s)
- Gianni Bisogno
- Pediatric Hematology Oncology Division, University Hospital of Padua, Padua, Italy
| | - Veronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy, Université Paris-Saclay, Villejuif, France
| | - Ilaria Zanetti
- Pediatric Hematology Oncology Division, University Hospital of Padua, Padua, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Soledad Gallego
- Department of Pediatric Oncology and Hematology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Raquel Dávila Fajardo
- Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Henry Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, Surrey, United Kingdom
| | - Anna Kelsey
- Department of Paediatric Histopathology, Manchester University Foundation Trust, Manchester, United Kingdom
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
| | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, Paris, France
| | | | | | - Myriam Ben-Arush
- Rambam Medical Center, Joan and Sanford Weill Pediatric Hematology Oncology and Bone Marrow Transplantation Division, Ruth Rappaport Children's Hospital, Haifa, Israel
| | - Heidi Glosli
- Centre for Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Peter Mudry
- Pediatric Oncology, Department University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Sima Ferman
- Pediatric Oncology Department, National Cancer Institute, Rio de Janeiro, Brazil
| | - Christine Devalck
- Pediatric Hematology and Oncology, Hôpital Universitaire des Enfants Reine Fabiola, HUDERF, ULB, HUB, Brussels, Belgium
| | | | - Johannes Hendrikus Maria Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Meriel Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
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Gough J, Mowat S, Sellman L, Robinson K, Youings M, Mandeville H. Institutional experience of using active breathing control for paediatric and teenage patients receiving thoraco-abdominal radiotherapy. Clin Transl Radiat Oncol 2023; 39:100575. [PMID: 36686562 PMCID: PMC9850023 DOI: 10.1016/j.ctro.2022.100575] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction Active Breathing Control (ABC) is a motion management strategy that facilitates reproducible breath-hold for thoracic radiotherapy (RT), which may reduce radiation dose to organs at risk (OARs). Reduction of radiation-induced toxicity is of high importance in younger patients. However, there is little published literature on the feasibility of ABC in this group. The purpose of this study was to report our experience of using ABC for paediatric and teenage patients. Methods Patients ≤18 years referred for thoracic RT using ABC at our centre from 2013-2021 were identified. Electronic records were retrospectively reviewed to obtain information on diagnosis, RT dose and technique, OAR dosimetry, tolerability of ABC, post-treatment imaging and early toxicity rates. Results 12 patients completed RT and were able to comply with ABC during planning and for the duration of RT. Median age was 15.5 years (10-18 years). Diagnoses were: Hodgkin lymphoma (n = 5), mediastinal B-cell lymphoma (n = 1), Ewing sarcoma (n = 5) and rhabdomyosarcoma (n = 1). For mediastinal RT cases (n = 6), median dose delivered was 30.6Gy(19.8-40Gy), median mean heart dose was 11.4Gy(4.8-19.4Gy), median mean lung dose was 9.9Gy(5.7-14.5Gy) and mean lung V20 was 10.9%. For ipsilateral RT cases, (n = 6), median hemithorax and total doses to primary tumour were 18Gy(15-20Gy) and 52.2Gy(36-60Gy) respectively. Median mean heart dose was 19.5Gy(10.6-33.2Gy) and median mean lung dose was 17.7Gy(16.3-30.5Gy). Mean bilateral lung V20 was 39.6%. Median mean contralateral lung dose was 5.2Gy(3.5-11.6Gy) and mean contralateral lung V20 was 1.5%. At a median follow-up of 36 months, only 1 patient had symptomatic radiation pneumonitis having received further thoracic RT following relapse. Conclusions ABC is feasible and well tolerated in younger patients receiving RT. Children as young as 10 years are able to comply. Use of ABC results in OAR dosimetry which is comparable to similar data in adults and can facilitate RT for extensive thoracic sarcoma.
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Affiliation(s)
- Jessica Gough
- The Royal Marsden Hospital, Sutton, UK,The Institute of Cancer Research, London, UK,Corresponding author at: Royal Marsden Hospital, Downs road, Sutton SM2 5PT, UK.
| | | | | | | | | | - Henry Mandeville
- The Royal Marsden Hospital, Sutton, UK,The Institute of Cancer Research, London, UK
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Ahmed MM, Zacharoulis S, Bodi I, Pace E, Mandeville H, Stone J, Elias T, Zebian B, Carceller F. Is it possible to achieve long-term survival in relapsed intracranial non-germinomatous germ cell tumours? Pediatr Blood Cancer 2023; 70:e29839. [PMID: 35735220 DOI: 10.1002/pbc.29839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Mohamed Magdy Ahmed
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Stergios Zacharoulis
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, UK.,Department of Pediatrics, Irving Medical Center, Columbia University, New York, USA
| | - Istvan Bodi
- Department of Clinical Neuropathology, Kings College NHS Foundation Trust, London, UK
| | - Erika Pace
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Henry Mandeville
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Joanna Stone
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Tony Elias
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,Department of Neurosurgery, Brighton & Sussex University Hospitals, Brighton, UK
| | - Bassel Zebian
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Fernando Carceller
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, UK.,Division of Clinical Studies, The Institute of Cancer Research, London, UK
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Souici C, Courtot T, Klobowski L, Blasiak-Wal I, Welsh L, Mandeville H. Target and organ-at-risk (OAR) delineation for VMAT craniospinal irradiation using Raystation's Automatic Atlas Based Segmentation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Morfouace M, Hol M, Schoot R, Arruti N, Wiersma J, Mandeville H, Dávila-Fajardo R, Pieters B, Saeed P, Bel A, Indelicato D. Exploration of dose-toxicity for ophthalmological adverse events in pediatric head and neck rhabdomyosarcoma survivors. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Rogers T, Zanetti I, Coppadoro B, Martelli H, Jenney M, Minard-Colin V, Terwisscha van Scheltinga SEJ, Skerritt C, Fajardo RD, Guérin F, Kelsey A, Merks JHM, Mandeville H, Guillén G, Glosli H, De Corti F, Bisogno G. Perianal/perineal rhabdomyosarcoma: Results of the SIOP MMT 95, Italian RMS 96, and EpSSG RMS 2005 studies. Pediatr Blood Cancer 2022; 69:e29739. [PMID: 35460336 DOI: 10.1002/pbc.29739] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/08/2022] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVES Rhabdomyosarcoma of the perianal/perineal region (PRMS) is rare, with poor survival and limited understanding of the functional consequences of treatment. DESIGN/METHODS International Society of Pediatric Oncology (SIOP) malignant mesenchymal tumor (MMT) 95, Italian RMS 96, and European paediatric Soft tissue sarcoma Study Group (EpSSG) RMS 2005 studies were interrogated to identify factors that impact survival; in RMS 2005, functional outcomes were analyzed. RESULTS Fifty patients (nonmetastatic) were identified, median age 6.4 years (range: 0.1-19.6): 29 male, 21 female. Tumors were >5 cm in 33 patients. Histopathological subtype was alveolar in 35. Lymph nodes were involved in 23 patients. In RMS 2005, 16/21 (76%) tested alveolar tumors had positive FOXO1 fusion status. Diagnostic biopsy was performed in 37. Primary resection (13) was complete (R0) in one. Delayed primary excision (16) was complete in three. Radiotherapy (RT) in 34/50 patients included external beam (28), brachytherapy (3), and both (3). Nodal RT was given in 16/23 N1 patients (70%). Median follow-up of alive patients (29) was 84.1 months (range: 3.6-221.1). Relapse or progression occurred in 24 patients (48%), 87% were fatal and most events (63%) were locoregional. Five-year event-free survival (EFS) was 47.8 (95% CI: 32.8-61.3), and 5-year overall survival (OS) was 52.6 (95% CI: 36.7-66.2), with age ≥10 years and tumor size >5 cm impacting 5-year EFS and OS (p < .05). Functional outcome data showed bowel, genito-urinary, and psychological issues; fecal incontinence in four of 21 survivors, and urinary symptoms in two of 21. CONCLUSIONS About 60% of patients with nonmetastatic PRMS survive; older patients and those with large tumors have the worst outcomes. Biopsy should be the initial procedure, and definitive local therapy individualized. Quality-of-life and functional studies are needed to better understand the consequences of treatment.
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Affiliation(s)
- Timothy Rogers
- Department of Pediatric Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ilaria Zanetti
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Beatrice Coppadoro
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Hélène Martelli
- Department of Pediatric Surgery, University Paris-Saclay, Bicêtre Hospital, Paris, France
| | - Meriel Jenney
- Department of Pediatric Oncology, University Hospital of Wales, Cardiff, UK
| | | | | | - Clare Skerritt
- Department of Pediatric Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Florent Guérin
- Department of Pediatric Surgery, University Paris-Saclay, Bicêtre Hospital, Paris, France
| | - Anna Kelsey
- Department of Pathology, Central Manchester University Hospitals, Manchester, UK
| | | | - Henry Mandeville
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | - Gabriela Guillén
- Department of Paediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Heidi Glosli
- Department of Paediatric Research, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Federica De Corti
- Pediatric Surgery Unit, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
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13
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Casey DL, Mandeville H, Bradley JA, Ter Horst SAJ, Sheyn A, Timmermann B, Wolden SL. Local control of parameningeal rhabdomyosarcoma: An expert consensus guideline from the International Soft Tissue Sarcoma Consortium (INSTRuCT). Pediatr Blood Cancer 2022; 69:e29751. [PMID: 35484997 DOI: 10.1002/pbc.29751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/03/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 12/19/2022]
Abstract
The International Soft Tissue Sarcoma Database Consortium (INSTRuCT) consists of a collaboration between the Children's Oncology Group (COG) Soft Tissue Sarcoma Committee, the European pediatric Soft Tissue Sarcoma Study Group (EpSSG), and the Cooperative Weichteilsarkom Studiengruppe (CWS). As part of the larger initiative of INSTRuCT to provide consensus expert opinions for clinical treatment of pediatric soft tissue sarcoma, we sought to provide updated, evidenced-based consensus guidelines for local treatment of parameningeal rhabdomyosarcoma using both existing literature as well as recommendations from the relevant cooperative group clinical trials. Overall, parameningeal rhabdomyosarcoma represents a distinctly challenging disease to treat, given its location near many critical structures in the head and neck, frequently advanced local presentation, and predilection for local failure. Definitive chemoradiation remains the standard treatment approach for parameningeal rhabdomyosarcoma, with surgery often limited to biopsy or salvage therapy for recurrent disease. In this consensus paper, we specifically discuss consensus guidelines and evidence for definitive local management with radiotherapy, with a focus on imaging for radiotherapy planning, dose and timing of radiation, approach for nodal irradiation, various radiation techniques, including proton therapy, and the limited role of surgical resection.
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Affiliation(s)
- Dana L Casey
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Henry Mandeville
- Royal Marsden NHS Foundation Trust, London, UK.,Institute of Cancer Research, London, UK
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida, USA
| | - Simone A J Ter Horst
- Department of Radiology, University Medical Center Utrecht, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Anthony Sheyn
- Department of Surgery, Division of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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14
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Chavaz L, Janssens GO, Bolle S, Mandeville H, Ramos-Albiac M, Van Beek K, Benghiat H, Hoeben B, Morales La Madrid A, Seidel C, Kortmann RD, Hargrave D, Gandola L, Pecori E, van Vuurden DG, Biassoni V, Massimino M, Kramm CM, von Bueren AO. Neurological Symptom Improvement After Re-Irradiation in Patients With Diffuse Intrinsic Pontine Glioma: A Retrospective Analysis of the SIOP-E-HGG/DIPG Project. Front Oncol 2022; 12:926196. [PMID: 35814457 PMCID: PMC9259094 DOI: 10.3389/fonc.2022.926196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/09/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study is to investigate the spectrum of neurological triad improvement in patients with diffuse intrinsic pontine glioma (DIPG) treated by re-irradiation (re-RT) at first progression. Methods We carried out a re-analysis of the SIOP-E retrospective DIPG cohort by investigating the clinical benefits after re-RT with a focus on the neurological triad (cranial nerve deficits, ataxia, and long tract signs). Patients were categorized as “responding” or “non-responding” to re-RT. To assess the interdependence between patients’ characteristics and clinical benefits, we used a chi-square or Fisher’s exact test. Survival according to clinical response to re-RT was calculated by the Kaplan–Meier method. Results As earlier reported, 77% (n = 24/31) of patients had any clinical benefit after re-RT. Among 25/31 well-documented patients, 44% (n = 11/25) had improvement in cranial nerve palsies, 40% (n = 10/25) had improvement in long-tract signs, and 44% (11/25) had improvement in cerebellar signs. Clinical benefits were observed in at least 1, 2, or 3 out of 3 symptoms of the DIPG triad, in 64%, 40%, and 24%, respectively. Patients irradiated with a dose ≥20 Gy versus <20 Gy may improve slightly better with regard to ataxia (67% versus 23%; p-value = 0.028). The survival from the start of re-RT to death was not different between responding and non-responding DIPG patients (p-value = 0.871). Conclusion A median re-irradiation dose of 20 Gy provides a neurological benefit in two-thirds of patients with an improvement of at least one symptom of the triad. DIPG patients receiving ≥20 Gy appear to improve slightly better with regard to ataxia; however, we need more data to determine whether dose escalation up to 30 Gy provides additional benefits.
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Affiliation(s)
- Lara Chavaz
- Department of Pediatrics, Gynecology and Obstetrics, Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
- Cansearch Research Platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Geert O. Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Stephanie Bolle
- Department of Radiation Oncology, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Henry Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | | | - Karen Van Beek
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Helen Benghiat
- Department of Clinical Oncology, University Hospital Birmingham, Birmingham, United Kingdom
| | - Bianca Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Clemens Seidel
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Germany
| | | | - Darren Hargrave
- Pediatric Oncology Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Emilia Pecori
- Pediatric Radiotherapy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Dannis G. van Vuurden
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Veronica Biassoni
- Pediatrics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatrics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Christof M. Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Andre O. von Bueren
- Department of Pediatrics, Gynecology and Obstetrics, Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
- Cansearch Research Platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
- *Correspondence: Andre O. von Bueren,
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15
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Chavaz L, Janssens GO, Bolle S, Mandeville H, Ramos-Albiac M, van Beek K, Benghiat H, Hoeben B, La Madrid AM, Seidel C, Kortmann RD, Hargrave D, Gandola L, Pecori E, van Vuurden DG, Biassoni V, Massimino M, Kramm C, von Bueren AO. DIPG-24. Neurological symptom improvement after re-irradiation in patients with diffuse intrinsic pontine glioma (DIPG): A retrospective analysis of the SIOP-E-HGG/DIPG project. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
PURPOSE: To investigate the spectrum of neurological triad improvement in patients with diffuse intrinsic pontine glioma (DIPG) treated by re-irradiation (re-RT) at first progression. METHODS: Re-analysis of the SIOP-E retrospective DIPG cohort by investigating clinical benefits after re-RT with focus on the neurological triad. Patients were divided as "responding" or "non-responding" to re-RT. To assess the interdependence between patients’ characteristics and clinical benefits we used a Chi-Square or Fisher’s Exact test. Survival according to clinical response to re-RT was calculated by the Kaplan-Meier method. RESULTS: As earlier reported, 77% (n = 24/31) of patients had any clinical benefit after re-RT. Among 25/31 well documented patients, 44% (n=11/25) had improvement in cranial nerve palsies, 40% (n=10/25) in long-tract signs, 44% (11/25) in cerebellar signs. Clinical benefits were observed in at least 1, 2 or 3 out of 3 symptoms of the DIPG triad, in 64%, 40% and 24% respectively. Patients irradiated with a dose ≥ 20 Gy versus < 20 Gy may improve slightly better with regards of ataxia (67% versus 23%; P-value = 0.028). The survival from the start of re-RT to death was not different between responding and non-responding DIPG patients (P-value = 0.871). CONCLUSION: A median re-irradiation dose of 20 Gy provides a neurological benefit in two-third of patients with an improvement of at least one symptom of the triad. DIPG patients receiving ≥20 Gy appear to improve slightly better with regards of ataxia, however we need more data to determine whether dose escalation up to 30 Gy provides additional benefit.
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Affiliation(s)
- Lara Chavaz
- Department of Pediatrics, Gynecology and Obstetrics, Division of Pediatric Hematology and Oncology, University Hospital of Geneva , Geneva , Switzerland
- Cansearch Research platform for pediatric oncology and hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics , Geneva , Switzerland
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht , Utrecht , Netherlands
- Princess Maxima Center for Pediatric Oncology , Utrecht, Utrecht , Netherlands
| | - Stephanie Bolle
- Department of Radiation Oncology, Gustave Roussy Cancer Institute, Paris Saclay University , Villejuif , France
| | - Henry Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital and Institute of Cancer Research , Sutton , United Kingdom
| | - Monica Ramos-Albiac
- Department of Radiation Oncology, Hospital Vall d’Hebron , Barcelona , Spain
| | - Karen van Beek
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven , Leuven , Belgium
| | - Helen Benghiat
- Department of Clinical Oncology, University Hospital Birmingham , Birmingham , United Kingdom
| | - Bianca Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht , Utrecht , Netherlands
- Princess Maxima Center for Pediatric Oncology , Utrecht, Utrecht , Netherlands
| | | | - Clemens Seidel
- Department of Radiation-Oncology, University Hospital Leipzig , Leipzig , Germany
| | - Rolf-Dieter Kortmann
- Department of Radiation-Oncology, University Hospital Leipzig , Leipzig , Germany
| | - Darren Hargrave
- Pediatric Oncology Unit, Great Ormond Street Hospital for Children , London , United Kingdom
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Emilia Pecori
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Dannis G van Vuurden
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pediatric Oncology , Amsterdam , Netherlands
- Princess Maxima Center for Pediatric Oncology , Utrecht, Utrecht , Netherlands
| | - Veronica Biassoni
- Pediatrics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Maura Massimino
- Pediatrics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Christof Kramm
- Division of Pediatric Hematology and Oncology, University Hospital Goettingen , Goettingen , Germany
| | - Andre O von Bueren
- Department of Pediatrics, Gynecology and Obstetrics, Division of Pediatric Hematology and Oncology, University Hospital of Geneva , Geneva , Switzerland
- Cansearch Research platform for pediatric oncology and hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics , Geneva , Switzerland
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16
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Mandeville H. SP-0691 Against the motion (rebuttal). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Gough J, Mowat S, Robinson K, Sellman L, Youings M, Mandeville H. PD-0169 Active breathing control for children and teenage patients receiving thoracic radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Stankunaite R, George SL, Gallagher L, Jamal S, Shaikh R, Yuan L, Hughes D, Proszek PZ, Carter P, Pietka G, Heide T, James C, Tari H, Lynn C, Jain N, Portela LR, Rogers T, Vaidya SJ, Chisholm JC, Carceller F, Szychot E, Mandeville H, Angelini P, Jesudason AB, Jackson M, Marshall LV, Gatz SA, Anderson J, Sottoriva A, Chesler L, Hubank M. Circulating tumour DNA sequencing to determine therapeutic response and identify tumour heterogeneity in patients with paediatric solid tumours. Eur J Cancer 2022; 162:209-220. [PMID: 34933802 DOI: 10.1016/j.ejca.2021.09.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 08/04/2021] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Clinical diagnostic sequencing of circulating tumour DNA (ctDNA) is well advanced for adult patients, but application to paediatric cancer patients lags behind. METHODS To address this, we have developed a clinically relevant (67 gene) NGS capture panel and accompanying workflow that enables sensitive and reliable detection of low-frequency genetic variants in cell-free DNA (cfDNA) from children with solid tumours. We combined gene panel sequencing with low pass whole-genome sequencing of the same library to inform on genome-wide copy number changes in the blood. RESULTS Analytical validity was evaluated using control materials, and the method was found to be highly sensitive (0.96 for SNVs and 0.97 for INDEL), specific (0.82 for SNVs and 0.978 for INDEL), repeatable (>0.93 [95% CI: 0.89-0.95]) and reproducible (>0.87 [95% CI: 0.87-0.95]). Potential for clinical application was demonstrated in 39 childhood cancer patients with a spectrum of solid tumours in which the single nucleotide variants expected from tumour sequencing were detected in cfDNA in 94.4% (17/18) of cases with active extracranial disease. In 13 patients, where serial samples were available, we show a close correlation between events detected in cfDNA and treatment response, demonstrate that cfDNA analysis could be a useful tool to monitor disease progression, and show cfDNA sequencing has the potential to identify targetable variants that were not detected in tumour samples. CONCLUSIONS This is the first pan-cancer DNA sequencing panel that we know to be optimised for cfDNA in children for blood-based molecular diagnostics in paediatric solid tumours.
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Affiliation(s)
- Reda Stankunaite
- Molecular Pathology Section, The Institute of Cancer Research, London, UK; Clinical Genomics, The Royal Marsden NHS Foundation, London, UK; Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK.
| | - Sally L George
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Lewis Gallagher
- Molecular Pathology Section, The Institute of Cancer Research, London, UK; Clinical Genomics, The Royal Marsden NHS Foundation, London, UK.
| | - Sabri Jamal
- Molecular Pathology Section, The Institute of Cancer Research, London, UK; Clinical Genomics, The Royal Marsden NHS Foundation, London, UK.
| | - Ridwan Shaikh
- Molecular Pathology Section, The Institute of Cancer Research, London, UK; Clinical Genomics, The Royal Marsden NHS Foundation, London, UK.
| | - Lina Yuan
- Molecular Pathology Section, The Institute of Cancer Research, London, UK; Clinical Genomics, The Royal Marsden NHS Foundation, London, UK.
| | - Debbie Hughes
- Molecular Pathology Section, The Institute of Cancer Research, London, UK; Clinical Genomics, The Royal Marsden NHS Foundation, London, UK.
| | - Paula Z Proszek
- Molecular Pathology Section, The Institute of Cancer Research, London, UK; Clinical Genomics, The Royal Marsden NHS Foundation, London, UK.
| | - Paul Carter
- Molecular Pathology Section, The Institute of Cancer Research, London, UK; Clinical Genomics, The Royal Marsden NHS Foundation, London, UK.
| | - Grzegorz Pietka
- Molecular Pathology Section, The Institute of Cancer Research, London, UK; Clinical Genomics, The Royal Marsden NHS Foundation, London, UK.
| | - Timon Heide
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK.
| | - Chela James
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK.
| | - Haider Tari
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK; Glioma Lab, The Institute of Cancer Research, London, UK.
| | - Claire Lynn
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK.
| | - Neha Jain
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Laura Rey Portela
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Tony Rogers
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK.
| | - Sucheta J Vaidya
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Julia C Chisholm
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Fernando Carceller
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Elwira Szychot
- Oak Centre for Children and Young People, Royal Marsden NHS Foundation Trust Hospital, Sutton, UK; Department of Paediatrics, Paediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland.
| | - Henry Mandeville
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Paola Angelini
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Angela B Jesudason
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Michael Jackson
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Lynley V Marshall
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Susanne A Gatz
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK; Sarcoma Molecular Pathology Team, Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, UK.
| | - John Anderson
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Developmental Biology and Cancer Programme, UCL GOS Institute of Child Health, London, UK.
| | - Andrea Sottoriva
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK.
| | - Louis Chesler
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Michael Hubank
- Molecular Pathology Section, The Institute of Cancer Research, London, UK; Clinical Genomics, The Royal Marsden NHS Foundation, London, UK.
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Milgrom SA, Million L, Mandeville H, Safwat A, Ermoian RP, Terezakis S. Non-rhabdomyosarcoma soft-tissue sarcoma. Pediatr Blood Cancer 2021; 68 Suppl 2:e28279. [PMID: 33818885 DOI: 10.1002/pbc.28279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/29/2020] [Accepted: 02/27/2020] [Indexed: 11/07/2022]
Abstract
Non-rhabdomyosarcoma soft-tissue sarcomas (NRSTS) comprise 4% of childhood cancers and consist of numerous histologic subtypes. Prognostic factors associated with poor outcome include high histologic grade, large tumor size, presence of metastases, and unresectability. Complete surgical resection is critical for the best oncologic outcomes and is prioritized in treatment algorithms. The use of radiation therapy (RT) and chemotherapy is based upon factors such as resectability, histologic grade, tumor size, and stage. North American and European trials are defining a risk-based approach to NRSTS to limit treatment-related toxicity and to maximize therapeutic efficacy. In this paper, we summarize the current roles of surgery, RT, and chemotherapy in NRSTS and describe ongoing research that is advancing the care of NRSTS patients.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Denver, Colorado
| | - Lynn Million
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Henry Mandeville
- Department of Radiation Oncology, Royal Marsden Hospital, London, UK
| | - Akmal Safwat
- Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Ralph P Ermoian
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Stephanie Terezakis
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota
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20
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Mul J, Melchior P, Seravalli E, Saunders D, Bolle S, Cameron AL, Gurtner K, Harrabi S, Lassen-Ramshad Y, Lavan N, Magelssen H, Mandeville H, Boterberg T, Kroon PS, Kotte AN, Hoeben BA, van Rossum PS, van Grotel M, Graf N, van den Heuvel-Eibrink MM, Rübe C, Janssens GO. Inter-clinician delineation variation for a new highly-conformal flank target volume in children with renal tumors: A SIOP-Renal Tumor Study Group international multicenter exercise. Clin Transl Radiat Oncol 2021; 28:39-47. [PMID: 33796796 PMCID: PMC7995478 DOI: 10.1016/j.ctro.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Recently, the SIOP-RTSG developed a highly-conformal flank target volume definition for children with renal tumors. The aims of this study were to evaluate the inter-clinician delineation variation of this new target volume definition in an international multicenter setting and to explore the necessity of quality assurance. MATERIALS AND METHODS Six pediatric renal cancer cases were transferred to ten radiation oncologists from seven European countries ('participants'). These participants delineated the pre- and postoperative Gross Tumor Volume (GTVpre/post), and Clinical Target Volume (CTV) during two test phases (case 1-2 and 3-4), followed by guideline refinement and a quality assurance phase (case 5-6). Reference target volumes (TVref) were established by three experienced radiation oncologists. The Dice Similarity Coefficient between the reference and participants (DSCref/part) was calculated per case. Delineations of case 5-6 were graded by four independent reviewers as 'per protocol' (0-4 mm), 'minor deviation' (5-9 mm) or 'major deviation' (≥10 mm) from the delineation guideline using 18 standardized criteria. Also, a major deviation resulting in underestimation of the CTVref was regarded as an unacceptable variation. RESULTS A total of 57/60 delineation sets were completed. The median DSCref/part for the CTV was 0.55 without improvement after sequential cases (case 3-4 vs. case 5-6: p = 0.15). For case 5-6, a major deviation was found for 5/18, 12/17, 18/18 and 4/9 collected delineations of the GTVpre, GTVpost, CTV-T and CTV-N, respectively. An unacceptable variation from the CTVref was found for 7/9 participants for case 5 and 6/9 participants for case 6. CONCLUSION This international multicenter delineation exercise demonstrates that the new consensus for highly-conformal postoperative flank target volume delineation leads to geometrical variation among participants. Moreover, standardized review showed an unacceptable delineation variation in the majority of the participants. These findings strongly suggest the need for additional training and centralized pre-treatment review when this target volume delineation approach is implemented on a larger scale.
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Key Words
- AA, abdominal aorta
- AP/PA, Anterior-Posterior/Posterior-Anterior
- CT, Computed Tomography
- CTV-N, Clinical Target Volume of the lymph node area
- CTV-T, Clinical Target Volume of the primary Tumor
- DICOM, Digital Imaging and Communications in Medicine
- DSC, Dice Similarity Coefficient
- Flank target volume
- GTVpre/post, pre- and postoperative Gross Tumor Volume respectively
- HR, High-Risk
- Highly-conformal radiotherapy
- IGRT, Image-Guided Radiotherapy
- IMRT, Intensity-Modulated Radiotherapy
- IR, Intermediate-Risk
- IVC, inferior vena cava
- Inter-clinician variation
- MRI, Magnetic Resonance Imaging
- OAR, organs at risk
- Pediatric renal tumors
- Quality assurance
- RT, radiotherapy
- RTOG, Radiation Oncology Group
- RTSG, Renal Tumor Study Group
- SIOP, International Society for Pediatric Oncology
- TVintersect, intersect target volume
- TVref, reference target volumes
- WT, Wilms’ tumor
- Wilms tumor
- n.a., not applicable
- part, participant
- ref, reference
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Affiliation(s)
- Joeri Mul
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Patrick Melchior
- Dept. of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel Saunders
- Dept. of Clinical Oncology, The Christie Hospital, Manchester, United Kingdom
| | - Stephanie Bolle
- Dept. of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Alison L. Cameron
- Bristol Cancer Institute, University Hospitals, Bristol, United Kingdom
| | - Kristin Gurtner
- Dept. of Radiation Oncology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Semi Harrabi
- Dept. of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Naomi Lavan
- St. Luke’s Radiation Oncology Network, Dublin, Ireland
| | | | - Henry Mandeville
- Dept. of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Tom Boterberg
- Dept. of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Petra S. Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexis N.T.J. Kotte
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bianca A.W. Hoeben
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter S.N. van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Norbert Graf
- Dept. of Pediatric Oncology, Saarland University Hospital, Homburg, Germany
| | | | - Christian Rübe
- Dept. of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - 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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21
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Gallego S, Chi YY, De Salvo GL, Li M, Merks JH, Rodeberg DA, Terwisscha van Scheltinga S, Mascarenhas L, Orbach D, Jenney M, Million L, Minard-Colin V, Wolden S, Zanetti I, Parham DM, Mandeville H, Venkatramani R, Bisogno G, Hawkins DS. Alveolar rhabdomyosarcoma with regional nodal involvement: Results of a combined analysis from two cooperative groups. Pediatr Blood Cancer 2021; 68:e28832. [PMID: 33245207 PMCID: PMC8414760 DOI: 10.1002/pbc.28832] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 09/28/2020] [Revised: 10/26/2020] [Accepted: 11/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment of children and adolescents with alveolar rhabdomyosarcoma (ARMS) and regional nodal involvement (N1) have been approached differently by North American and European cooperative groups. In order to define a better therapeutic strategy, we analyzed two studies conducted between 2005 and 2016 by the European paediatric Soft tissue sarcoma Study Group (EpSSG) and Children's Oncology Group (COG). METHODS We retrospectively identified patients with ARMS N1 enrolled in either EpSSG RMS2005 or in COG ARST0531. Chemotherapy in RMS2005 comprised ifosfamide + vincristine + dactinomycin + doxorubicin (IVADo), IVA and maintenance (vinorelbine, cyclophosphamide); in ARST0531, it consisted of either vincristine + dactinomycin + cyclophosphamide (VAC) or VAC alternating with vincristine + irinotecan (VI). Local treatment was similar in both protocols. RESULTS The analysis of the clinical characteristics of 239 patients showed some differences between study groups: in RMS2005, advanced Intergroup Rhabdomyosarcoma Study Group (IRS) and large tumors predominated. There were no differences in outcomes between the two groups: 5-year event-free survival (EFS), 49% (95% confidence interval [CI]: 39-59) and 44% (95% CI: 30-58), and overall survival (OS), 51% (95% CI: 41-61) and 53.6% (95% CI: 40-68) in RMS2005 and ARST0531, respectively. In RMS2005, EFS of patients with FOXO1-positive tumors was significantly inferior to those with FOXO1-negative (49.3% vs 73%, P = .034). In contrast, in ARST0531, EFS of patients with FOXO1-positive tumors was 45% compared with 43.8% for those with FOXO1-negative. CONCLUSIONS The outcome of patients with ARMS N1 was similar in both protocols. However, patients with FOXO1 fusion-negative tumors enrolled in RMS2005 showed a significantly better outcome, suggesting that different strategies of chemotherapy may have an impact in the outcome of this subgroup of patients.
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Affiliation(s)
| | - Yueh-Yun Chi
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, US
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, Veneto Oncologic Institute IOV-IRCCS, Padova, Italy
| | - Minjie Li
- University of Florida, Gainesville, Florida, US
| | | | | | | | - Leo Mascarenhas
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, US
| | - Daniel Orbach
- SIREDO Oncology Center, Institute Curie, Paris, PSL University, France
| | - Meriel Jenney
- Children Hospital for Wales Cardiff and Vale University Health Board, Cardiff, UK
| | - Lynn Million
- Stanford University School of Medicine, Stanford, US
| | | | - Suzanne Wolden
- Memorial Sloan Kettering Cancer Center, New York, NY, US
| | | | - David M. Parham
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, US
| | | | | | | | - Douglas S. Hawkins
- Seattle Children’s Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, US
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22
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Huijskens SC, Kroon PS, Gaze MN, Gandola L, Bolle S, Supiot S, Abakay CD, Alexopoulou A, Bokun J, Chojnacka M, Escande A, Giralt J, Harrabi S, Maduro JH, Mandeville H, Mussano A, Napieralska A, Padovani L, Scarzello G, Timmermann B, Claude L, Seravalli E, Janssens GO. Radical radiotherapy for paediatric solid tumour metastases: An overview of current European protocols and outcomes of a SIOPE multicenter survey. Eur J Cancer 2021; 145:121-131. [PMID: 33461061 DOI: 10.1016/j.ejca.2020.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/22/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE/OBJECTIVE About 20% of children with solid tumours (ST) present with distant metastases (DM). Evidence regarding the use of radical radiotherapy of these DM is sparse and open for personal interpretation. The aim of this survey was to review European protocols and to map current practice regarding the irradiation of DM across SIOPE-affiliated countries. MATERIALS/METHODS Radiotherapy guidelines for metastatic sites (bone, brain, distant lymph nodes, lung and liver) in eight European protocols for rhabdomyosarcoma, non-rhabdomyosarcoma soft-tissue sarcoma, Ewing sarcoma, neuroblastoma and renal tumours were reviewed. SIOPE centres irradiating ≥50 children annually were invited to participate in an online survey. RESULTS Radiotherapy to at least one metastatic site was recommended in all protocols, except for high-risk neuroblastoma. Per protocol, dose prescription varied per site, and information on delineation and treatment planning/delivery was generally missing. Between July and September 2019, 20/27 centres completed the survey. Around 14% of patients were deemed to have DM from ST at diagnosis, of which half were treated with curative intent. A clear cut-off for a maximum number of DM was not used in half of the centres. Regardless of the tumour type and site, conventional radiotherapy regimens were most commonly used to treat DM. When stereotactic radiotherapy was used, a wide range of fractionation regimens were applied. CONCLUSION Current radiotherapy guidelines for DM do not allow a consistent approach in a multicentre setting. Prospective (randomised) trials are needed to define the role of radical irradiation of DM from paediatric ST.
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Affiliation(s)
- Sophie C Huijskens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra S Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals, London, UK
| | - Lorenza Gandola
- Paediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stephanie Bolle
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Stephane Supiot
- Oncologie Radiotherapie, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Candan D Abakay
- Department of Radiation Oncology, Uludag University, Bursa, Turkey
| | | | - Jelena Bokun
- Institute of Oncology and Radiology of Serbia, Belgrado, Serbia
| | - Marzanna Chojnacka
- Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Center-Institute, Warsaw, Poland
| | - Alexandre Escande
- Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Jordi Giralt
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Semi Harrabi
- Department of Radiation Oncology and Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
| | - John H Maduro
- Department of Radiation Oncology, University Medical Center Groningen/Groningen Proton Center, Groningen, The Netherlands; Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | | | - Anna Mussano
- Department of Radiation Oncology, Citta della Salute e della Scienza, Torino, Italy
| | - Aleksandra Napieralska
- Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Laetitia Padovani
- Department of Radiation Oncology, Centre Hospitalier Universitaire, Marseille, France
| | - Giovanni Scarzello
- Department of Radiation Oncology, Veneto Institute of Oncology, Padua, Italy
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Line Claude
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France
| | - Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
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23
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Ajithkumar T, Mandeville H, Carceller F, Ronghe M, Foord T, Lowis S, Kwok-Williams M, Calaminus G, Murray M, Nicholson J. GCT-61. CORRELATION OF PATTERNS OF DISEASE RECURRENCE WITH RADIOTHERAPY TECHNIQUES AND DOSE IN INTRACRANIAL GERM CELL TUMOURS (icGCT): LESSONS FROM THE UK COHORT OF SIOP GCT96 STUDY. Neuro Oncol 2020. [PMCID: PMC7715078 DOI: 10.1093/neuonc/noaa222.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
There are global variations in radiotherapy approaches for icGCT. An understanding of patterns of disease recurrence correlated with radiation techniques and doses is important in standardising and improving the quality of radiotherapy using high-precision techniques.
METHODS AND RESULTS
Data from 20 patients with tumour recurrence after treatment within the SIOP GCT96 study in the UK were analysed. Seven (35%) patients had germinoma and 13 (65%) had non-germinoma. Twelve patients had local recurrence, 5 had metastatic and 3 had local and metastatic disease. Radiotherapy details were retrieved in only 8 patients (40%). Six patients had received focal radiotherapy and two craniospinal radiotherapy. Of the patients who received focal radiotherapy, 4 had recurrence within the radiation portal, one had periventricular recurrence and one had marker-positive recurrence with no radiological lesions. Both patients who received CSI recurred within the CSF space. The main reasons for poor retrieval of treatment details were difficulty in retrieving archived information and that the study was conducted during a period before PACS or electronic radiotherapy records.
CONCLUSION
This study highlights the importance prospective data collection and analysis to understand the patterns of recurrence in icGCT. Even within a prospective study, radiotherapy techniques varied between centres. There is therefore an urgent need for centralised radiological review and prospective radiotherapy quality assurance measures in future clinical trials.
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Affiliation(s)
| | | | | | - Milind Ronghe
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Tina Foord
- Churchill Hospital, Oxford, United Kingdom
| | - Stephen Lowis
- University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | | | - Matthew Murray
- Cambridge University Hospital, Cambridge, United Kingdom
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Morcavallo A, Mandeville H, Barker K, Richardson S, Lindsey J, Lockett N, Boult JKR, Robinson SP, Oelfke U, Williamson D, Clifford SC, Chesler L. MBRS-33. TEMPORARY RESTORATION OF p53 ACTIVITY DURING FRACTIONATED RADIOTHERAPY IN A GROUP3 MEDULLOBLASTOMA GEMM REPRESENTS A POWERFUL TOOL FOR RADIOBIOLOGY STUDIES. Neuro Oncol 2020. [PMCID: PMC7715786 DOI: 10.1093/neuonc/noaa222.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
TP53 pathway alterations are well-described events in medulloblastoma (MB) and are predictive of poor clinical outcome. Alterations are rare at diagnosis in Group3 (Gr3) and Group4, but enriched in Sonic Hedgehog and WNT subgroups. However, TP53 mutations are observed in all subgroups at relapse. Radiation therapy, along with surgery and chemotherapy, represents the standard of care treatment for MB. Loss of p53 function correlates with increased resistance to radiation in several cancers conferring poor survival for patients. In this study, we exposed the MYCN-driven/Trp53kiki (with tamoxifen-inducible p53 activation) Gr3 MB GEMM to a clinically relevant fractionated radiation therapy (RT) regime, to assess the role of p53 in Gr3 radio-resistance and relapse. Mice exhibiting tumour progression (bioluminescence (BLI) signal >109 photons/second) were randomized to treatment groups. A small animal radiation research platform was used to deliver CT-guided cranio-spinal irradiation (CSI) and a cranial boost (CB). Mice were followed for survival and tumour burden tracked using BLI. Bodyweight was monitored to evaluate treatment tolerability. Full dose radiation therapy (54Gy CB, 36Gy CSI, α/β=10) or dose modulation (12Gy CB, 8Gy CSI) was performed. The results showed comparable primary tumour regression in response to RT in p53 inactive and active backgrounds, followed by imminent relapse or prolonged remission respectively. No significant acute toxicity was observed. Temporary activation of p53 during RT improved tumour-free survival and decreased the incidence of relapse. In conclusion, we developed a new model which will help improve understanding of the radiobiology of high-risk MB and future preclinical trials.
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Affiliation(s)
- Alaide Morcavallo
- Division of Clinical Studies, The Institute of Cancer Research, and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Henry Mandeville
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Karen Barker
- Division of Clinical Studies, The Institute of Cancer Research, and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Stacey Richardson
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Janet Lindsey
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Nikita Lockett
- Division of Clinical Studies, The Institute of Cancer Research, and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Jessica K R Boult
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, Surrey, United Kingdom
| | - Simon P Robinson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, Surrey, United Kingdom
| | - Uwe Oelfke
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Daniel Williamson
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Steven C Clifford
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Louis Chesler
- Division of Clinical Studies, The Institute of Cancer Research, and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
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Tan I, Francis J, Smyth G, Burland H, Eagle S, Mandeville H. PO-1874: Improving Treatment Accuracy of Cranial Boost Radiotherapy (RT) with Total Body Irradiation (TBI). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Huijskens S, Kroon P, Demiroz Abakay C, Timmermann B, Giralt J, Gaze M, Harrabi S, Scarzello G, Alexopoulou A, Padovani L, Escande A, Gandola L, Supiot S, Chojnacka M, Bokun J, Napieralska A, Rombi B, Maduro J, Bolle S, Mussano A, Mandeville H, Claude L, Seravalli E, Janssens G. OC-0454: Current radiotherapy practice for children with metastases from solid tumors: SIOPE survey analysis. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00476-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Terwisscha van Scheltinga SEJ, Wijnen MHWA, Martelli H, Rogers T, Mandeville H, Gaze MN, McHugh K, Corradini N, Orbach D, Jenney M, Kelsey A, Chisholm J, Gallego S, Glosli H, Ferrari A, Zanetti I, De Salvo GL, Minard-Colin V, Bisogno G, van Noesel MM, Merks HHM. Local staging and treatment in extremity rhabdomyosarcoma. A report from the EpSSG-RMS2005 study. Cancer Med 2020; 9:7580-7589. [PMID: 32869534 PMCID: PMC7571832 DOI: 10.1002/cam4.3365] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023] Open
Abstract
Rhabdomyosarcoma of the extremities present with two main challenges: correct evaluation of initial regional nodal involvement and define adequate local treatment. METHODS Pediatric patients with localized rhabdomyosarcoma of the extremity included in the EpSSG-RMS2005 study between 2005 and 2014 were evaluated for staging, treatment, and survival. The outcome was compared to the preceding European SIOP-MMT studies. RESULTS Of the 162 patients included, histology was unfavorable in 113 (70%), 124 (77%) were younger than 10 years, 128 (79%) were IRS III, and 47 (29%) were node-positive. A regional node biopsy was performed in 97 patients (60%) and modified the lymph node stage in 15/97 (16%). Primary and delayed surgery was performed in 155 (96%) and radiotherapy delivered in 118 (73%) patients. Relapse occurred in 61 cases (38%), local in 14 (23%), regional in 13 (21%), distant in 22 (36%), and combined relapse in 12 (20%) with five progressive diseases (8%) and four secondary tumors (7%). Five-year event free (EFS) and overall survival (OS) were 58.4% (95%CI, 50.3-65.7) and 71.7% (63.6-78.4), respectively. In the previous studies MMT89 and MMT95, tumor surgery was performed in 32/53 (60%) and 74/82(90%), respectively, and radiotherapy delivered in 13/53 (25%) and 26/82 (30%), respectively. Five-year EFS and OS were 35.6%, and 50.3% in MMT89 and 54.3% and 68.2% in the MMT95 study. CONCLUSIONS Even if the lymph node staging was not always complete according to the RMS2005 protocol, node sampling changed lymph node status in a significant number of patients. Despite the higher rate of patients treated with locoregional radiotherapy, survival in RMS2005 did not improve compared to the previous European SIOP-MMT95 study.
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Affiliation(s)
| | - Marc H W A Wijnen
- Pediatric Surgery, Pediatric Solid Tumor Unit, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Hélène Martelli
- Department of Pediatric Surgical Oncology, University Hospital Bicětre, Bicětre, France
| | - Timothy Rogers
- Department of Pediatric Surgery, University Hospitals Bristol NHS foundation trust, Bristol, UK
| | - Henry Mandeville
- Children and Young People's Unit, Royal Marsden Hospital, Sutton, UK
| | - Mark N Gaze
- Department of Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Keiran McHugh
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Nadege Corradini
- Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, Paris, France
| | - Meriel Jenney
- Department of Pediatric Oncology, University hospital of Wales, Cardiff, UK
| | - Anna Kelsey
- Department of Pathology, Central Manchester University Hospitals, Manchester, United Kingdom
| | - Julia Chisholm
- Children and Young People's Department, Royal Marsden Hospital, Sutton, United Kingdom
| | - Soledad Gallego
- Pediatric Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Heidi Glosli
- Division of Pediatric and Adolescent Medicine, Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ilaria Zanetti
- Clinical Trials and Biostatistics Unit, IRCCS Istituto oncologico Veneto, Padova, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto oncologico Veneto, Padova, Italy
| | | | - Giani Bisogno
- Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Max M van Noesel
- Pediatric Solid Tumor Unit, Princess Maxima Center for pediatric Oncology, Utrecht, The Netherlands
| | - Hans H M Merks
- Pediatric Solid Tumor Unit, Princess Maxima Center for pediatric Oncology, Utrecht, The Netherlands
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Alves I, Bodi I, Jarosz J, Mandeville H, Zebian B, Carceller F. Radiological pseudoprogression post-radiotherapy in a child with pineal germ cell tumour. Pediatr Blood Cancer 2020; 67:e28407. [PMID: 32426927 DOI: 10.1002/pbc.28407] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/02/2020] [Accepted: 04/26/2020] [Indexed: 11/08/2022]
Abstract
Little is known about pseudoprogression in brain tumours other than gliomas. A 9-year-old male child with a pineal teratoma/germinoma underwent surgical resection followed by adjuvant chemo-radiotherapy. The magnetic resonance imaging scan 4 months post-radiotherapy showed a contrast-enhancing lesion within the surgical cavity suspicious of recurrence. These radiological findings subsequently resolved without any specific intervention. The child continues in remission 2 years post-treatment. This case illustrates the occurrence of pseudoprogression post-radiotherapy in intracranial GCT and highlights an unmet need for greater implementation of functional imaging techniques in paediatric neuro-oncology to avoid undue discontinuation of effective treatments or inappropriate enrolment in clinical trials.
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Affiliation(s)
- Inês Alves
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, UK.,Department of Paediatric Oncology, University Hospital Centre of São João, Porto, Portugal
| | - Istvan Bodi
- Department of Neuropathology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jozef Jarosz
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Henry Mandeville
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.,Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Bassel Zebian
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Fernando Carceller
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, UK.,Division of Clinical Studies, The Institute of Cancer Research, London, UK
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Chandy E, Taylor H, Gaito S, Wells E, Jones C, Meehan C, Burland H, Stone J, Snowball C, Mashru J, Riddell C, Hon Y, Welsh L, Saran F, Mandeville H. Hypofractionated Stereotactic Ablative Radiotherapy for Recurrent or Oligometastatic Tumours in Children and Young Adults. Clin Oncol (R Coll Radiol) 2020; 32:316-326. [DOI: 10.1016/j.clon.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/09/2019] [Accepted: 10/20/2019] [Indexed: 12/13/2022]
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Szychot E, Seunarine KK, Robles CA, Mandeville H, Mankad K, Clark C, Peregud-Pogorzelski J, Desouza N. Estimating brain volume loss after radiation therapy in children treated for posterior fossa tumors (Corpus callosum and whole brain volume changes following radiotherapy in children). ADV CLIN EXP MED 2020; 29:331-337. [PMID: 32237285 DOI: 10.17219/acem/114827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND More than half of pediatric tumors of central nervous system (CNS) primarily originate in the posterior fossa and are conventionally treated with radiation therapy (RT). OBJECTIVES The objective of this study was to establish whether corpus callosum volumes (CCV) and whole brain volumes (WBV) are correlated and to determine the impact of whole-brain lowvs high-dose RT on brain parenchymal volume loss as assessed using each technique. MATERIAL AND METHODS Of the 30 identified children (6-12 years) with newly diagnosed posterior fossa tumors treated with cranial RT, including focal and whole-brain RT, suitable imaging was obtained for 23. Radiotherapy regimens were the following: no whole-brain RT (Group 1, n = 7), low-dose whole-brain RT (<30 Gy, Group 2, n = 9) and high-dose whole-brain RT (>30 Gy, Group 3, n = 7) in addition to focal boost. Magnetic resonance images (MRIs) were analyzed at baseline and follow-up (median 14 months). The CCVs were manually segmented on midline sagittal slice (n = 23), while WBVs were segmented semi-automatically using Freesurfer (n = 15). This was done twice (6-month interval) for all baseline CCV measurements and 5 randomly selected WBV measurements to establish measurement reproducibility. Correlations between CCV and WBV were investigated and percentage of children demonstrating reduction in CCV or WBV noted. RESULTS Correlation between baseline CCV and WBV was not significant (p = 0.37). Measurement reproducibility was from 6% to -9% for CCV and from 4.8% to -1.2% for WBV. Among the children studied, 30.4% (7/23) had >9% reduction in CCV at follow-up, while 33.3% (5/15) had >1.2% reduction in WBV. Five of 7 patients with CCV loss were not picked up by WBV measurements. Similarly, 3 of 5 patients with WBV loss were not picked up by CCV measurements. CONCLUSIONS The CCV and the WBV are unrelated and may indicate different brain parenchymal losses following RT. Up to a third of posterior fossa tumors treated with RT have measurable CCV or WBV loss; incidence was equivalent in lowvs high-dose whole-brain RT.
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Affiliation(s)
- Elwira Szychot
- The Oak Centre for Children and Young People, Royal Marsden Hospital, Sutton, London, UK
| | - Kiran K. Seunarine
- Developmental Imaging and Biophysics Section, Institute of Child Health, University College London, UK
| | - Carlos Andrés Robles
- Department of Radiology, Exequiel Gonzalez Cortes Children's Hospital, Santiago, Chile
| | - Henry Mandeville
- The Oak Centre for Children and Young People, Royal Marsden Hospital, Sutton, London, UK
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christopher Clark
- Developmental Imaging and Biophysics Section, Institute of Child Health, University College London, UK
| | | | - Nandita Desouza
- CRUK Imaging Centre at The Institute of Cancer Research, Sutton, London, UK
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Mowat S, Smyth G, Mandeville H, Blasiak-Wal I, Warren-Oseni K, Welsh L. Implementing VMAT craniospinal irradiation on a conventional linac. Radiography (Lond) 2020. [DOI: 10.1016/j.radi.2019.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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32
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Hol M, Suttie M, Hammond P, Slater O, Mandeville H, Gaze M, Chisholm J, Pieters B, Pazira H, Wiersma J, Merks H, Davila R, Becking A, Smeele L. Facial deformations in patients treated for head and neck rhabdomyosarcoma, the difference between treatment modalities and a dose-effect relation for specific facial bones. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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George SL, Izquierdo E, Campbell J, Koutroumanidou E, Proszek P, Jamal S, Hughes D, Yuan L, Marshall LV, Carceller F, Chisholm JC, Vaidya S, Mandeville H, Angelini P, Wasti A, Bexelius T, Thway K, Gatz SA, Clarke M, Al-Lazikani B, Barone G, Anderson J, Tweddle DA, Gonzalez D, Walker BA, Barton J, Depani S, Eze J, Ahmed SW, Moreno L, Pearson A, Shipley J, Jones C, Hargrave D, Jacques TS, Hubank M, Chesler L. A tailored molecular profiling programme for children with cancer to identify clinically actionable genetic alterations. Eur J Cancer 2019; 121:224-235. [PMID: 31543384 PMCID: PMC6839402 DOI: 10.1016/j.ejca.2019.07.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 04/18/2019] [Revised: 06/27/2019] [Accepted: 07/23/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND For children with cancer, the clinical integration of precision medicine to enable predictive biomarker-based therapeutic stratification is urgently needed. METHODS We have developed a hybrid-capture next-generation sequencing (NGS) panel, specifically designed to detect genetic alterations in paediatric solid tumours, which gives reliable results from as little as 50 ng of DNA extracted from formalin-fixed paraffin-embedded (FFPE) tissue. In this study, we offered an NGS panel, with clinical reporting via a molecular tumour board for children with solid tumours. Furthermore, for a cohort of 12 patients, we used a circulating tumour DNA (ctDNA)-specific panel to sequence ctDNA from matched plasma samples and compared plasma and tumour findings. RESULTS A total of 255 samples were submitted from 223 patients for the NGS panel. Using FFPE tissue, 82% of all submitted samples passed quality control for clinical reporting. At least one genetic alteration was detected in 70% of sequenced samples. The overall detection rate of clinically actionable alterations, defined by modified OncoKB criteria, for all sequenced samples was 51%. A total of 8 patients were sequenced at different stages of treatment. In 6 of these, there were differences in the genetic alterations detected between time points. Sequencing of matched ctDNA in a cohort of extracranial paediatric solid tumours also identified a high detection rate of somatic alterations in plasma. CONCLUSION We demonstrate that tailored clinical molecular profiling of both tumour DNA and plasma-derived ctDNA is feasible for children with solid tumours. Furthermore, we show that a targeted NGS panel-based approach can identify actionable genetic alterations in a high proportion of patients.
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Affiliation(s)
- Sally L George
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Elisa Izquierdo
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK; Glioma Team, Division of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, UK
| | - James Campbell
- Bioinformatics Core Facility, The Institute of Cancer Research, London, UK
| | - Eleni Koutroumanidou
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Paula Proszek
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Sabri Jamal
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Deborah Hughes
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Lina Yuan
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Lynley V Marshall
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Fernando Carceller
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Julia C Chisholm
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Sucheta Vaidya
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Henry Mandeville
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Paola Angelini
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Ajla Wasti
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Tomas Bexelius
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Khin Thway
- Pathology Department, Royal Marsden NHS Foundation Trust, London, UK
| | - Susanne A Gatz
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK; Sarcoma Molecular Pathology Team, Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, UK; Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Matthew Clarke
- Glioma Team, Division of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, UK
| | - Bissan Al-Lazikani
- Bioinformatics Core Facility, The Institute of Cancer Research, London, UK
| | - Giuseppe Barone
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - John Anderson
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Developmental Biology and Cancer Programme, UCL GOS Institute of Child Health, London, UK
| | - Deborah A Tweddle
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - David Gonzalez
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK; Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, UK
| | - Brian A Walker
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK; Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jack Barton
- Developmental Biology and Cancer Programme, UCL GOS Institute of Child Health, London, UK
| | - Sarita Depani
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jessica Eze
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Department of Histology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Saira W Ahmed
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Department of Histology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucas Moreno
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK; HNJ-CNIO Clinical Research Unit, Hospital Universitario Nino Jesus, Madrid, Spain; Paediatric Oncology & Haematology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrew Pearson
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Janet Shipley
- Sarcoma Molecular Pathology Team, Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, UK
| | - Chris Jones
- Glioma Team, Division of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, UK
| | - Darren Hargrave
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas S Jacques
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Department of Histology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michael Hubank
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Louis Chesler
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
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Roy Moulik N, Vaidya S, Mandeville H, Chisholm JC. Managing peritoneal involvement in children and young people with rhabdomyosarcoma: A single-center experience from the United Kingdom. Pediatr Blood Cancer 2019; 66:e27805. [PMID: 31131973 DOI: 10.1002/pbc.27805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/04/2018] [Revised: 03/05/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022]
Abstract
We describe our experience in managing nine children and adolescents with rhabdomyosarcoma (RMS) and peritoneal involvement. The radiological pattern of peritoneal involvement was diverse from only ascites to solid peritoneal mass/omental caking. Treatment included systemic chemotherapy in all, surgery in three, and radiotherapy in eight. Two patients with presumed nonmalignant ascites, no solid peritoneal metastasis, nonalveolar histology, near-complete resection of residual disease, and radiotherapy survived long term. One patient has just completed treatment, and the remaining six relapsed/progressed at the time of reporting. Five of six patients died after a median of 5 (3-7) months from relapse despite second-line chemotherapy.
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Affiliation(s)
- Nirmalya Roy Moulik
- Children and Young People's Unit, Royal Marsden Hospital, Sutton, United Kingdom
| | - Sucheta Vaidya
- Children and Young People's Unit, Royal Marsden Hospital, Sutton, United Kingdom
| | - Henry Mandeville
- Children and Young People's Unit, Royal Marsden Hospital, Sutton, United Kingdom
| | - Julia C Chisholm
- Children and Young People's Unit, Royal Marsden Hospital, Sutton, United Kingdom
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Drabbe C, Benson C, Younger E, Zaidi S, Jones RL, Judson I, Chisholm J, Mandeville H, Fisher C, Thway K, Al Muderis O, Messiou C, Strauss D, Husson O, Miah A, Van der Graaf WTA. Embryonal and Alveolar Rhabdomyosarcoma in Adults: Real-Life Data From a Tertiary Sarcoma Centre. Clin Oncol (R Coll Radiol) 2019; 32:e27-e35. [PMID: 31350181 DOI: 10.1016/j.clon.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/25/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
AIMS Embryonal and alveolar rhabdomyosarcoma (ERMS, ARMS) are subtypes of RMS that mainly occur in children, with relatively good outcomes. The incidence in adults is extremely low and survival is significantly worse compared with children. Data are scarce and literature generally combines all RMS subtypes, including pleomorphic RMS, which primarily occurs in adults and behaves more like undifferentiated pleomorphic sarcoma. The aim of this study was to evaluate patient and tumour characteristics, outcome and prognostic factors in adult patients with ERMS and ARMS. MATERIALS AND METHODS All adult (18 years or older) ERMS and ARMS patients (presenting 1990-2016) were identified from a prospectively maintained database and were included in this analysis. RESULTS Overall, 66 patients were included (42 men, 24 women). The median age at presentation was 28 years (range 18-71). The median overall survival for all ARMS (n = 42) and ERMS (n = 24) patients was 18 months, with a 5-year overall survival rate of 27%. Patients presenting with localised disease (n = 38, 58%) and metastatic disease (n = 25, 42%), had a 5-year overall survival rate of 36% and 11%, respectively. In univariate analysis we found alveolar subtype, fusion gene positivity, infiltrative tumour and metastatic presentation to be negative prognostic factors. CONCLUSION Survival in adult ERMS and ARMS patients is poor and the current data may be useful in the design of trials with novel agents. Ideally, paediatric and adult oncologists should set up trials together to get a better understanding of biological, genetic and clinically relevant factors in this disease.
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Affiliation(s)
- C Drabbe
- Royal Marsden Hospital, London, UK; Radboud University Medical Centre, Nijmegen, the Netherlands
| | - C Benson
- Royal Marsden Hospital, London, UK
| | | | - S Zaidi
- Royal Marsden Hospital, London, UK
| | - R L Jones
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - I Judson
- The Institute of Cancer Research, London, UK
| | - J Chisholm
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - H Mandeville
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - C Fisher
- The Institute of Cancer Research, London, UK
| | - K Thway
- Royal Marsden Hospital, London, UK
| | | | - C Messiou
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | | | - O Husson
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - A Miah
- Royal Marsden Hospital, London, UK
| | - W T A Van der Graaf
- Royal Marsden Hospital, London, UK; Radboud University Medical Centre, Nijmegen, the Netherlands; The Institute of Cancer Research, London, UK.
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Fog LS, Hansen VN, Kjær-Kristoffersen F, Berlon TE, Petersen PM, Mandeville H, Specht L. A step and shoot intensity modulated technique for total body irradiation. Tech Innov Patient Support Radiat Oncol 2019; 10:1-7. [PMID: 32095540 PMCID: PMC7033804 DOI: 10.1016/j.tipsro.2019.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/14/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction Total body irradiation (TBI) is a part of the conditioning regimen for bone marrow transplant.At the Royal Marsden (Sutton, UK) and Rigshospitalet (Copenhagen, Denmark), we introduced a step and shoot IMRT (SS IMRT) technique for TBI. This technique requires no equipment other than that used to deliver other external beam radiation. In this paper, we describe this technique and report on data from the two clinics. Materials and methods The patients were positioned supine, supported by vacuum bag(s). The entire body of the patients were CT scanned with 5 mm slices. Multiple multi-leaf collimator (MLC) defined fields were used.In-vivo dosimetry was performed at the Royal Marsden for 113 patients.Calculated doses for 18 adult and 4 paediatric patients from Rigshospitalet were extracted. Results The in-vivo data from the Royal Marsden showed that the mean TLD measured dose difference was -1.9% with a standard deviation of 4.5%.SS IMRT plans for 22 patients from Rigshospitalet resulted in mean doses to the brain, lungs and kidneys all within the range of 11.1-11.8 Gy, while the V(12 Gy) was below 5% for the brain, 2% for the lungs and 0% for the kidneys. Discussion SS IMRT is feasible for TBI and can deliver targeted doses to the organs at risk.
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Affiliation(s)
- Lotte S Fog
- Dept. of Oncology, Rigshospitalet, University of Copenhagen, Denmark
| | - Vibeke N Hansen
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Tim Egholm Berlon
- Dept. of Oncology, Rigshospitalet, University of Copenhagen, Denmark
| | | | | | - Lena Specht
- Dept. of Oncology, Rigshospitalet, University of Copenhagen, Denmark
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Janssens GO, Timmermann B, Laprie A, Mandeville H, Padovani L, Chargari C, Journy N, Kameric L, Kienesberger A, Brunhofer M, Kozhaeva O, Gasparotto C, Kearns P, Boterberg T, Lievens Y, Vassal G. Recommendations for the organisation of care in paediatric radiation oncology across Europe: a SIOPE-ESTRO-PROS-CCI-Europe collaborative project in the framework of the JARC. Eur J Cancer 2019; 114:47-54. [PMID: 31059973 DOI: 10.1016/j.ejca.2019.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 02/19/2019] [Accepted: 03/04/2019] [Indexed: 12/17/2022]
Abstract
Disparities in survival and long-term side-effects from paediatric cancer are observed across European Society for Paediatric Oncology (SIOPE)-affiliated countries. The Joint Action on Rare Cancers (JARC) is a project supported by the European Union and member states aiming to formulate recommendations on rare cancers, including paediatric malignancies, to reduce inequalities and to improve health outcomes. Most paediatric cancers are treated by a combination of systemic agents, surgery and/or radiotherapy. Radiotherapy for children is becoming increasingly complex because of the growing availability of new modalities and techniques and the evolution in molecular biology. These added challenges have the potential to enhance disparities in survival and side-effects between countries, but also among centres in the same country. To tackle radiotherapy-related inequalities, representatives of SIOPE, European SocieTy for Radiotherapy and Oncology, Paediatric Radiation Oncology Society and Childhood Cancer International-Europe defined 'standard' and 'optional' levels to deliver Good Clinical Practice-compliant treatment in paediatric radiation oncology with a focus on patient-related care, education and training. In addition, more than 250 paediatric radiotherapy centres across the SIOPE-affiliated countries have been mapped. For a better understanding of resources in paediatric radiotherapy, JARC representatives are working on an online survey for paediatric radiation oncologists of each centre in SIOPE-affiliated countries. The outcome of this survey will give an insight into the strengths and weaknesses of paediatric radiotherapy across SIOPE-affiliated countries and can be relevant for European Reference Networks in terms of collaboration pathways and referrals in paediatric radiotherapy.
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Affiliation(s)
- Geert O Janssens
- Department of Radiation Oncology, University Medical Centre Utrecht, the Netherlands; Princess Maxima Centre for Paediatric Oncology, Utrecht, the Netherlands.
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), German Cancer Consortium (DKTK), Germany
| | - Anne Laprie
- Department of Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Toulouse NeuroImaging Center, ToNIC, INSERM Université Toulouse III Paul Sabatier, Toulouse, France
| | - Henry Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Laetitia Padovani
- Department of Radiation Oncology, CRCM, UMR 1068 Inserm 7258 CNRS, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Neige Journy
- INSERM Unit 1018, Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiations Group, Gustave Roussy, Villejuif, France
| | - Lejla Kameric
- Childhood Cancer International - Europe, Vienna, Austria
| | | | | | - Olga Kozhaeva
- European Society for Paediatric Oncology (SIOP Europe), Brussels, Belgium
| | - Chiara Gasparotto
- European Society for Radiotherapy & Oncology (ESTRO), Brussels, Belgium
| | - Pamela Kearns
- European Society for Paediatric Oncology (SIOP Europe), Brussels, Belgium; European Society for Radiotherapy & Oncology (ESTRO), Brussels, Belgium; Institute of Cancer and Genomic Sciences, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Yolande Lievens
- European Society for Radiotherapy & Oncology (ESTRO), Brussels, Belgium; Institute of Cancer and Genomic Sciences, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Gilles Vassal
- European Society for Paediatric Oncology (SIOP Europe), Brussels, Belgium; Department of Clinical Research, Gustave Roussy, Paris-Sud University, Paris, France
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Bishr M, Nicholson E, Durie E, Potter M, Ethell M, Anthias C, Messiou C, Johnson I, Eagle S, Ingram W, Saran F, Mandeville H. PO-0869 Reducing pulmonary and renal toxicity in children receiving TBI with forward planned IMRT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Llewelyn M, Smyth G, Lavan N, Nill S, Oelfke U, Mandeville H. PO-0874 The feasibility of MR-Linac treatment planning in childhood abdominal Neuroblastoma. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Carceller F, Jerome NP, Fowkes LA, Khabra K, Mackinnon A, Bautista F, Marshall LV, Vaidya S, Mandeville H, Morgan V, Leach MO, Koh DM. Post-radiotherapy apparent diffusion coefficient (ADC) in children and young adults with high-grade gliomas and diffuse intrinsic pontine gliomas. Pediatr Hematol Oncol 2019; 36:103-112. [PMID: 30978130 DOI: 10.1080/08880018.2019.1592267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/05/2019] [Indexed: 01/14/2023]
Abstract
Objectives: Diffusion-weighted magnetic resonance imaging (DW-MRI) offers potential to monitor response and predict survival in high-grade gliomas (HGG) and diffuse intrinsic pontine gliomas (DIPG). We hypothesized that post-radiotherapy DW-MRI may provide prognostic imaging biomarkers in children and young adults with these tumors. Methods: Patients aged ≤21 years diagnosed between 2005 and 2012 were eligible. The tumor median apparent diffusion coefficient (ADC) and its 5th percentile (C5-ADC) were determined at the first post-radiotherapy scan and at the time of radiological progression. DW-MRI parameters were correlated with survival endpoints, temozolomide use and pseudoprogression, when it occurred. Results: Out of 40 patients (20 HGG, 20 DIPG), 23 had evaluable DW-MRI post-radiotherapy and 25 at radiological progression. There were 6 episodes of pseudoprogression. Hazard ratios (95%CI) for progression-free survival were 0.998 (0.993-1.003) for median ADC and 1.003 (0.996-1.010) for C5-ADC. Hazard ratios (95%CI) for overall survival were 1.0009 (0.996-1.006) for median ADC and 0.998 (0.992-1.004) for C5-ADC. Post-radiotherapy median and C5-ADC values were not significantly different between patients treated with radiotherapy alone versus radiotherapy/temozolomide. The median and C5-ADC values were not significantly different at the time of pseudoprogression compared to those at tumor progression. Conclusions: Post-radiotherapy median ADC and C5-ADC were not prognostic, nor able to differentiate radiosensitization with temozolomide or occurrence of pseudoprogression in this cohort of HGG and DIPG patients. Further exploration of alternative DW parameters, study timepoints or data modeling may contribute to the development of prognostic/predictive imaging biomarkers for children and young adults with HGG or DIPG.
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Affiliation(s)
- Fernando Carceller
- a Paediatric Neuro-Oncology and Drug Development Teams, Children & Young People's Unit , The Royal Marsden NHS Foundation Trust , London , UK
- b Division of Clinical Studies and Cancer Therapeutics , The Institute of Cancer Research , London , UK
| | - Neil P Jerome
- c Cancer Research UK Cancer Imaging Centre , The Institute of Cancer Research , London , UK
- d Department of Circulation and Medical Imaging , NTNU - Norwegian University of Science and Technology , Trondheim , Norway
| | - Lucy A Fowkes
- e Department of Radiology , The Royal Marsden NHS Foundation Trust , London , UK
| | - Komel Khabra
- f The Royal Marsden NHS Foundation Trust , Research Data Management and Statistics Unit , London , UK
- g MRC Clinical Trials Unit, University College London , London , UK
| | - Andrew Mackinnon
- e Department of Radiology , The Royal Marsden NHS Foundation Trust , London , UK
| | | | - Lynley V Marshall
- a Paediatric Neuro-Oncology and Drug Development Teams, Children & Young People's Unit , The Royal Marsden NHS Foundation Trust , London , UK
- b Division of Clinical Studies and Cancer Therapeutics , The Institute of Cancer Research , London , UK
| | - Sucheta Vaidya
- a Paediatric Neuro-Oncology and Drug Development Teams, Children & Young People's Unit , The Royal Marsden NHS Foundation Trust , London , UK
- b Division of Clinical Studies and Cancer Therapeutics , The Institute of Cancer Research , London , UK
| | - Henry Mandeville
- i Department of Radiotherapy , The Royal Marsden NHS Foundation Trust , London , UK
| | - Veronica Morgan
- e Department of Radiology , The Royal Marsden NHS Foundation Trust , London , UK
| | - Martin O Leach
- c Cancer Research UK Cancer Imaging Centre , The Institute of Cancer Research , London , UK
| | - Dow-Mu Koh
- e Department of Radiology , The Royal Marsden NHS Foundation Trust , London , UK
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Wasti A, Carceller F, George S, Koutroumanidou E, Izquierdo E, Guerra P, Zarowiecki M, Campbell J, Al-Lazikani B, Marshall L, Jones C, Clarke M, Powell K, Crowe T, Rogers T, Chisholm J, Vaidya S, Mandeville H, Saran F, Zebian B, Hettige S, Al-Sarraj S, Bridges L, Jacques T, Hargrave D, Pearson A, Walker B, de Castro DG, Hubank M, Chesler L. EAPH-05. MOLECULAR PROFILING AND IDENTIFICATION OF TARGETED THERAPIES FOR CHILDREN AND YOUNG ADULTS WITH PRIMARY CENTRAL NERVOUS SYSTEM TUMOURS IN THE UNITED KINGDOM. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Fernando Carceller
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Sally George
- The Institute of Cancer Research, Sutton, UK
- The Royal Marsden Hospital, Sutton, UK
| | | | | | | | | | | | | | - Lynley Marshall
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Chris Jones
- The Institute of Cancer Research, Sutton, UK
| | | | | | | | | | - Julia Chisholm
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Sucheta Vaidya
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Henry Mandeville
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Frank Saran
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | | | | | | | | | | | | | - Andy Pearson
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Brian Walker
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Louis Chesler
- The Institute of Cancer Research, Sutton, UK
- The Royal Marsden Hospital, Sutton, UK
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Mackay A, Molinari V, Carvalho D, Pemberton H, Temelso S, Burford A, Clarke M, Fofana M, Boult J, Izquierdo E, Taylor K, Bjerke L, Salom JF, Kessler K, Rogers R, Chandler C, Zebian B, Martin A, Stapleton S, Hettige S, Marshall L, Carceller F, Mandeville H, Vaidya S, Bridges L, Al-Sarraj S, Pears J, Mastronuzzi A, Carai A, del Bufalo F, de Torres C, Sunol M, Cruz O, Mora J, Moore A, Robinson S, Lord C, Carcaboso AM, Vinci M, Jones C. HGG-23. DRUG SCREENING LINKED TO MOLECULAR PROFILING IDENTIFIES NOVEL DEPENDENCIES IN PATIENT-DERIVED PRIMARY CULTURES OF PAEDIATRIC HIGH GRADE GLIOMA AND DIPG. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jane Pears
- Our Lady Children’s Hospital, Dublin, Irel
| | | | | | | | | | | | | | - Jaume Mora
- Hospital San Joan de Deu, Barcelona, Spain
| | - Andrew Moore
- Queensland Children’s Tumour Bank, Brisbane, Australia
| | | | | | | | - Maria Vinci
- Ospedale Pediatrico Cambio Gesu, Rome, Italy
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Wasti A, Boesten T, Powell K, Marshall L, Vaidya S, Angelini P, Mandeville H, Saran F, Chisholm J, Jones C, Chandler C, Stapleton S, Bridges L, Al-Sarraj S, Carceller F. HGG-13. SURVIVAL OUTCOMES OF CHILDREN AND ADOLESCENTS WITH BI-THALAMIC GLIOMAS: THE SOUTH THAMES NEURO-ONCOLOGY UNIT EXPERIENCE. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Lynley Marshall
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Sucheta Vaidya
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Paola Angelini
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Henry Mandeville
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Frank Saran
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Julia Chisholm
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
| | - Chris Jones
- The Institute of Cancer Research, Sutton, UK
| | | | | | | | | | - Fernando Carceller
- The Royal Marsden Hospital, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
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Lavan N, Mc Quaid D, Smyth G, Vaidya S, Saran F, Oelfke U, Mandeville H. EP-2031: Kidney motion in children and young people quantified using 4DCT deformable registration. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32340-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Seravalli E, Bosman M, Smyth G, Alapetite C, Christiaens M, Gandola L, Hoeben B, Horan G, Koutsouveli E, Kusters M, Lassen Y, Losa S, Magelssen H, Marchant T, Mandeville H, Oldenburger F, Padovani L, Paraskevopoulou C, Rombi B, Visser J, Whitfield G, Schwarz M, Vestergaard A, Janssens G. OC-0345: Comparing cranio spinal irradiation planning for photon and proton techniques at 15 European centers. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Janssens GO, Gandola L, Bolle S, Mandeville H, Ramos-Albiac M, van Beek K, Benghiat H, Hoeben B, Morales La Madrid A, Kortmann RD, Hargrave D, Menten J, Pecori E, Biassoni V, von Bueren AO, van Vuurden DG, Massimino M, Sturm D, Peters M, Kramm CM. Survival benefit for patients with diffuse intrinsic pontine glioma (DIPG) undergoing re-irradiation at first progression: A matched-cohort analysis on behalf of the SIOP-E-HGG/DIPG working group. Eur J Cancer 2017; 73:38-47. [PMID: 28161497 DOI: 10.1016/j.ejca.2016.12.007] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/25/2016] [Accepted: 12/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Overall survival (OS) of patients with diffuse intrinsic pontine glioma (DIPG) is poor. The purpose of this study is to analyse benefit and toxicity of re-irradiation at first progression. METHODS At first progression, 31 children with DIPG, aged 2-16 years, underwent re-irradiation (dose 19.8-30.0 Gy) alone (n = 16) or combined with systemic therapy (n = 15). At initial presentation, all patients had typical symptoms and characteristic MRI features of DIPG, or biopsy-proven high-grade glioma. An interval of ≥3 months after upfront radiotherapy was required before re-irradiation. Thirty-nine patients fulfilling the same criteria receiving radiotherapy at diagnosis, followed by best supportive care (n = 20) or systemic therapy (n = 19) at progression but no re-irradiation, were eligible for a matched-cohort analysis. RESULTS Median OS for patients undergoing re-irradiation was 13.7 months. For a similar median progression-free survival after upfront radiotherapy (8.2 versus 7.7 months; P = .58), a significant benefit in median OS (13.7 versus 10.3 months; P = .04) was observed in favour of patients undergoing re-irradiation. Survival benefit of re-irradiation increased with a longer interval between end-of-radiotherapy and first progression (3-6 months: 4.0 versus 2.7; P < .01; 6-12 months: 6.4 versus 3.3; P = .04). Clinical improvement with re-irradiation was observed in 24/31 (77%) patients. No grade 4-5 toxicity was recorded. On multivariable analysis, interval to progression (corrected hazard ratio = .27-.54; P < .01) and re-irradiation (corrected hazard ratio = .18-.22; P < .01) remained prognostic for survival. A risk score (RS), comprising 5 categories, was developed to predict survival from first progression (ROC: .79). Median survival ranges from 1.0 month (RS-1) to 6.7 months (RS-5). CONCLUSIONS The majority of patients with DIPG, responding to upfront radiotherapy, do benefit of re-irradiation with acceptable tolerability.
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Affiliation(s)
- Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht and Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stephanie Bolle
- Department of Radiotherapy, Gustave Roussy Cancer Campus, Villejuif Cedex, France
| | - Henry Mandeville
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Karen van Beek
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Helen Benghiat
- Department of Clinical Oncology, University Hospital Birmingham, Birmingham, UK
| | - Bianca Hoeben
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | - Darren Hargrave
- Pediatric Oncology Unit, Great Ormond Street Hospital, London, UK
| | - Johan Menten
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Emilia Pecori
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Veronica Biassoni
- Pediatrics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andre O von Bueren
- Department of Hematology & Oncology, University of Geneva, Geneva, Switzerland; Department of Pediatric Hematology & Oncology, University Hospital Goettingen, Goettingen, Germany
| | - Dannis G van Vuurden
- Department of Pediatric Oncology & Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Maura Massimino
- Pediatrics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Dominik Sturm
- Division of Pediatric Neuro-oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht and Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Christof M Kramm
- Department of Pediatric Hematology & Oncology, University Hospital Goettingen, Goettingen, Germany
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Stone J, Waern S, Khabra K, Wharram B, Middleton A, Edwards L, Kuhlthau K, Crouch C, Marshall L, Zacharoulis S, Vaidya S, Powell K, Saran F, Yock T, Mandeville H. Impact of toxicities and neurocognitive impairment on the health related quality of life (HR-QoL) for survivors of medulloblastoma. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30631-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Indelicato DJ, Merchant T, Laperriere N, Lassen Y, Vennarini S, Wolden S, Hartsell W, Pankuch M, Brandal P, Law CCK, Taylor R, Laskar S, Okcu MF, Bouffet E, Mandeville H, Björk-Eriksson T, Nilsson K, Nyström H, Constine LS, Story M, Timmermann B, Roberts K, Kortmann RD. Consensus Report From the Stockholm Pediatric Proton Therapy Conference. Int J Radiat Oncol Biol Phys 2016; 96:387-392. [DOI: 10.1016/j.ijrobp.2016.06.2446] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/26/2016] [Accepted: 06/14/2016] [Indexed: 11/15/2022]
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Carceller F, Fowkes LA, Khabra K, Moreno L, Saran F, Burford A, Mackay A, Jones DTW, Hovestadt V, Marshall LV, Vaidya S, Mandeville H, Jerome N, Bridges LR, Laxton R, Al-Sarraj S, Pfister SM, Leach MO, Pearson ADJ, Jones C, Koh DM, Zacharoulis S. Pseudoprogression in children, adolescents and young adults with non-brainstem high grade glioma and diffuse intrinsic pontine glioma. J Neurooncol 2016; 129:109-21. [PMID: 27180091 DOI: 10.1007/s11060-016-2151-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 11/27/2015] [Accepted: 05/07/2016] [Indexed: 02/01/2023]
Abstract
Pseudoprogression (PsP) is a treatment-related phenomenon which hinders response interpretation. Its prevalence and clinical impact have not been evaluated in children/adolescents. We assessed the characteristics, risk factors and prognosis of PsP in children/adolescents and young-adults diagnosed with non-brainstem high grade gliomas (HGG) and diffuse intrinsic pontine gliomas (DIPG). Patients aged 1-21 years diagnosed with HGG or DIPG between 1995 and 2012 who had completed radiotherapy were eligible. PsP was assessed according to study-specific criteria and correlated with first-line treatment, molecular biomarkers and survival. Ninety-one patients (47 HGG, 44 DIPG) were evaluable. Median age: 10 years (range, 2-20). Eleven episodes of PsP were observed in 10 patients (4 HGG, 6 DIPG). Rates of PsP: 8.5 % (HGG); 13.6 % (DIPG). Two episodes of PsP were based on clinical findings alone; nine episodes had concurrent radiological changes: increased size of lesions (n = 5), new focal enhancement (n = 4). Temozolomide, MGMT methylation or H3F3A mutations were not found to be associated with increased occurrence of PsP. For HGG, 1-year progression-free survival (PFS) was 41.9 % no-PsP versus 100 % PsP (p = 0.041); differences in 1-year overall survival (OS) were not significant. For DIPG, differences in 1-year PFS and OS were not statistically significant. Hazard ratio (95 %CI) of PsP for OS was 0.551 (0.168-1.803; p = 0.325) in HGG; and 0.308 (0.107-0.882; p = 0.028) in DIPG. PsP occurred in both pediatric HGG and DIPG patients at a comparable rate to adult HGG. PsP was associated with improved 1-yr PFS in HGG patients. PsP had a protective effect upon OS in DIPG patients.
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Affiliation(s)
- Fernando Carceller
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- Division of Clinical Studies and Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK.
| | - Lucy A Fowkes
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Komel Khabra
- Research Data Management and Statistics Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Lucas Moreno
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Division of Clinical Studies and Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Clinical Research Unit - Pediatric Phase I-II Clinical Trials, Pediatric Oncology-Hematology Service, Hospital Niño Jesús, Av. de Menéndez Pelayo, num 65, 28009, Madrid, Spain
| | - Frank Saran
- Department of Neuro Oncology, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Anna Burford
- Division of Clinical Studies and Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Division of Molecular Pathology, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Alan Mackay
- Division of Clinical Studies and Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Division of Molecular Pathology, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69121, Heidelberg, Germany
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69121, Heidelberg, Germany
| | - Lynley V Marshall
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Division of Clinical Studies and Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Division of Molecular Pathology, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Sucheta Vaidya
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Division of Clinical Studies and Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Henry Mandeville
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Neil Jerome
- CRUK Cancer Imaging Centre, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Leslie R Bridges
- Department of Cellular Pathology, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Ross Laxton
- Department of Clinical Neuropathology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Safa Al-Sarraj
- Department of Clinical Neuropathology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69121, Heidelberg, Germany
- Department of Pediatric Oncology and Hematology, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Martin O Leach
- CRUK Cancer Imaging Centre, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Andrew D J Pearson
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Division of Clinical Studies and Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Chris Jones
- Division of Clinical Studies and Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Division of Molecular Pathology, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Stergios Zacharoulis
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Division of Clinical Studies and Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
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