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Rumley S, Pater L. Optimization of radiotherapy in Fanconi anemia-related medulloblastoma. Pediatr Blood Cancer 2024; 71:e30775. [PMID: 37988252 DOI: 10.1002/pbc.30775] [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: 09/16/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Sarah Rumley
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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2
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Hall J, Lui K, Tan X, Shumway J, Collichio F, Moschos S, Sengupta S, Chaudhary R, Quinsey C, Jaikumar S, Forbes J, Andaluz N, Zuccarello M, Struve T, Vatner R, Pater L, Breneman J, Weiner A, Wang K, Shen C. Factors associated with radiation necrosis and intracranial control in patients treated with immune checkpoint inhibitors and stereotactic radiotherapy. Radiother Oncol 2023; 189:109920. [PMID: 37769968 DOI: 10.1016/j.radonc.2023.109920] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND AND PURPOSE Emerging data suggest immune checkpoint inhibitors (ICI) and stereotactic radiosurgery (SRS) or radiotherapy (SRT) may work synergistically, potentially increasing both efficacy and toxicity. This manuscript characterizes factors associated with intracranial control and radiation necrosis in this group. MATERIALS AND METHODS All patients had non-small cell lung cancer, renal cell carcinoma, or melanoma and were treated from 2013 to 2021 at two institutions with ICI and SRS/SRT. Univariate and multivariate analysis were used to analyze factors associated with local failure (LF) and grade 2+ (G2 + ) radiation necrosis. RESULTS There were 179 patients with 549 metastases. The median follow up from SRS/SRT was 14.7 months and the median tumor size was 7 mm (46 tumors ≥ 20 mm). Rates of LF and G2 + radiation necrosis per metastasis were 5.8% (32/549) and 6.9% (38/549), respectively. LF rates for ICI +/- 1 month from time of radiation versus not were 3% (8/264) and 8% (24/285) (p = 0.01), respectively. G2 + radiation necrosis rates for PD-L1 ≥ 50% versus < 50% were 17% (11/65) and 3% (5/203) (p=<0.001), respectively. PD-L1 ≥ 50% remained significantly associated with G2 + radiation necrosis on multivariate analysis (p = 0.03). Rates of intracranial failure were 54% (80/147) and 17% (4/23) (p = 0.001) for those without and with G2 + radiation necrosis, respectively. CONCLUSIONS PD-L1 expression (≥50%) may be associated with higher rates of G2 + radiation necrosis, and there may be improved intracranial control following the development of radiation necrosis. Administration of ICIs with SRS/SRT is overall safe, and there may be some local control benefit to delivering these concurrently.
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Affiliation(s)
- Jacob Hall
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA.
| | - Kevin Lui
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Xianming Tan
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - John Shumway
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Frances Collichio
- Department of Medicine, Division of Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Stergios Moschos
- Department of Medicine, Division of Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Soma Sengupta
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Rekha Chaudhary
- Department of Medicine, Division of Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Carolyn Quinsey
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, USA
| | - Sivakumar Jaikumar
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, USA
| | - Jonathan Forbes
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Timothy Struve
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Ralph Vatner
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - John Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Ashley Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Kyle Wang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Colette Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
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McAleer MF, Melchior P, Parkes J, Pater L, Rübe C, Saunders D, Paulino AC, Janssens GO, Kalapurakal J. Harmonica consensus, controversies, and future directions in radiotherapy for pediatric Wilms tumors. Pediatr Blood Cancer 2022; 70 Suppl 2:e30090. [PMID: 36482883 DOI: 10.1002/pbc.30090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/21/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 12/13/2022]
Abstract
Radiotherapy (RT) is essential for multimodality treatment of pediatric renal tumors, particularly in higher-risk and metastatic disease. Despite decades of use, particularly for Wilms tumor, there remain controversies regarding RT indications, timing, dose, and targets. To align global management, we address these issues in this international HARMONIsation and CollAboration (HARMONICA) project. There are multiple knowledge gaps and opportunities for future research including: (1) utilization of advanced RT technologies, including intensity-modulated RT, proton beam therapy, combined with image-guided RT to reduce target volumes; (2) impact of molecular biomarkers including loss of heterozygosity at 1p, 16q, and 1q gain on RT indications; (3) mitigation of reproductive toxicity following RT; (4) promotion of RT late effects research; and (5) support to overcome challenges in RT utilization in low- and middle-income countries where 90% of the world's children reside. Here, we outline current status and future directions for RT in pediatric renal tumors.
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Affiliation(s)
- Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick Melchior
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.,Low- and Middle-Income Countries Committee Co-Chair, Paediatric Radiation Oncology Society, Cape Town, South Africa
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | | | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - John Kalapurakal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Meier T, Fort M, Lizaso M, Sudhoff M, Pater L, Kharofa J, Sittenfeld S. MSS05 Presentation Time: 4:05 PM. Brachytherapy 2022. [DOI: 10.1016/j.brachy.2022.09.057] [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: 12/04/2022]
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Shah S, Manzoor S, Rothman Y, Hagen M, Pater L, Golnik K, Mahammedi A, Lin AL, Bhabhra R, Forbes JA, Sengupta S. Complete Response of a Patient With a Mismatch Repair Deficient Aggressive Pituitary Adenoma to Immune Checkpoint Inhibitor Therapy: A Case Report. Neurosurgery 2022; 91:e51-e56. [PMID: 35544035 PMCID: PMC9514746 DOI: 10.1227/neu.0000000000002024] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/10/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Aggressive pituitary adenomas (APAs) are pituitary tumors that are refractory to standard treatments and carry a poor prognosis. Current treatment guidelines are not standardized but combine surgical resection, radiation therapy, and chemotherapy. Temozolomide is the only chemotherapeutic agent with documented effectiveness and is recommended for APA in European Society of Endocrinology clinical guidelines. CLINICAL PRESENTATION A 57-year-old man presented with visual deterioration and bitemporal hemianopsia. MRI of the brain demonstrated a sellar mass suspected to be pituitary macroadenoma with displacement of the stalk and optic nerve impingement. The patient underwent stereotactic endoscopic transsphenoidal resection of the mass. Postoperative MRI demonstrated gross total resection. Pathology revealed a sparsely granulated corticotroph adenoma with malignant transformation. Immunohistochemistry showed loss of expression of MLH1 and PMS2 in the tumor cells. Proton therapy was recommended given an elevated Ki67 index and p53 positivity. Before radiotherapy, there was no radiographic evidence of residual tumor. Temozolomide therapy was initiated after surveillance MRI showed recurrence at 16 months postoperatively. However, MRI demonstrated marked progression after 3 cycles. Next-generation sequencing using the MSK-IMPACT platform identified somatic mutations in MLH1 Y548lfs*9 and TP53 R337C . Immunotherapy with ipilimumab/nivolumab was initiated, and MRI demonstrated no residual tumor burden 34 months postoperatively. CONCLUSION APA is a tumor with frequent recurrence and a short median expected length of survival. Here, we demonstrate the utility of immunotherapy in a single case report of APA, with complete resolution of recurrent APA and improved survival compared with life expectancy.
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Affiliation(s)
- Sanjit Shah
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Saima Manzoor
- Department of Endocrinology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
- Current affiliation: Houston Methodist Hospital, Houston, Texas, USA
| | - Yehudit Rothman
- Department of Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Matthew Hagen
- Department of Pathology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Karl Golnik
- Department of Ophthalmology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Abdelkader Mahammedi
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Andrew L. Lin
- Departments of Neurology and Neurosurgery, Multidisciplinary Pituitary and Skull Base Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ruchi Bhabhra
- Department of Endocrinology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
- Current affiliation: University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Jonathan A. Forbes
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Soma Sengupta
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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van der Perk MEM, Cost NG, Bos AME, Brannigan R, Chowdhury T, Davidoff AM, Daw NC, Dome JS, Ehrlich P, Graf N, Geller J, Kalapurakal J, Kieran K, Malek M, McAleer MF, Mullen E, Pater L, Polanco A, Romao R, Saltzman AF, Walz AL, Woods AD, van den Heuvel-Eibrink MM, Fernandez CV. White paper: Onco-fertility in pediatric patients with Wilms tumor. Int J Cancer 2022; 151:843-858. [PMID: 35342935 PMCID: PMC9541948 DOI: 10.1002/ijc.34006] [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: 12/17/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022]
Abstract
The survival of childhood Wilms tumor is currently around 90%, with many survivors reaching reproductive age. Chemotherapy and radiotherapy are established risk factors for gonadal damage and are used in both COG and SIOP Wilms tumor treatment protocols. The risk of infertility in Wilms tumor patients is low but increases with intensification of treatment including the use of alkylating agents, whole abdominal radiation or radiotherapy to the pelvis. Both COG and SIOP protocols aim to limit the use of gonadotoxic treatment, but unfortunately this cannot be avoided in all patients. Infertility is considered one of the most important late effects of childhood cancer treatment by patients and their families. Thus, timely discussion of gonadal damage risk and fertility preservation options is important. Additionally, irrespective of the choice for preservation, consultation with a fertility preservation (FP) team is associated with decreased patient and family regret and better quality of life. Current guidelines recommend early discussion of the impact of therapy on potential fertility. Since most patients with Wilms tumors are prepubertal, potential FP methods for this group are still considered experimental. There are no proven methods for FP for prepubertal males (testicular biopsy for cryopreservation is experimental), and there is just a single option for prepubertal females (ovarian tissue cryopreservation), posing both technical and ethical challenges. Identification of genetic markers of susceptibility to gonadotoxic therapy may help to stratify patient risk of gonadal damage and identify patients most likely to benefit from FP methods.
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Affiliation(s)
| | - Nicholas G Cost
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and the Surgical Oncology Program of the Children's Hospital Colorado, Aurora, CO, USA
| | - Annelies M E Bos
- University Medical Center Utrecht, Reproductive Medicine and Gynaecology, Utrecht, Netherlands
| | - Robert Brannigan
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Tanzina Chowdhury
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA
| | - Najat C Daw
- Department of Pediatrics - Patient Care, MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Dome
- Division of Oncology at Children's National Hospital, Washington, DC, USA
| | - Peter Ehrlich
- University of Michigan, C.S. Mott Children's Hospital Section of Pediatric Surgery, Ann Arbor, MI, USA
| | - Norbert Graf
- Department for Pediatric Oncology and Hematology, Saarland University Medical Center, Homburg, Germany
| | - James Geller
- Division of Pediatric Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - John Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois, USA
| | - Kathleen Kieran
- Department of Urology, University of Washington, and Division of Urology, Seattle Children's Hospital, Seattle, USA
| | - Marcus Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Mary F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Mullen
- Department of Pediatric Oncology, Children's Hospital Boston/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Angela Polanco
- National Cancer Research Institute Children's Group Consumer Representative, London, UK
| | - Rodrigo Romao
- Departments of Surgery and Urology, IWK Health Centre, Dalhousie University, Halifax, Canada
| | | | - Amy L Walz
- Division of Hematology, Oncology, Neuro-Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Andrew D Woods
- Children's Cancer Therapy Development Institute, Beaverton, Oregon, USA
| | | | - Conrad V Fernandez
- Department of Pediatric Hematology/Oncology, IWK Health Centre and Dalhousie University, Halifax, Canada
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7
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Weiss BD, Yanik G, Naranjo A, Zhang FF, Fitzgerald W, Shulkin BL, Parisi MT, Russell H, Grupp S, Pater L, Mattei P, Mosse Y, Lai HA, Jarzembowski JA, Shimada H, Villablanca JG, Giller R, Bagatell R, Park JR, Matthay KK. A safety and feasibility trial of 131 I-MIBG in newly diagnosed high-risk neuroblastoma: A Children's Oncology Group study. Pediatr Blood Cancer 2021; 68:e29117. [PMID: 34028986 PMCID: PMC9150928 DOI: 10.1002/pbc.29117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/20/2021] [Revised: 04/02/2021] [Accepted: 04/27/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION 131 I-meta-iodobenzylguanidine (131 I-MIBG) is effective in relapsed neuroblastoma. The Children's Oncology Group (COG) conducted a pilot study (NCT01175356) to assess tolerability and feasibility of induction chemotherapy followed by 131 I- MIBG therapy and myeloablative busulfan/melphalan (Bu/Mel) in patients with newly diagnosed high-risk neuroblastoma. METHODS Patients with MIBG-avid high-risk neuroblastoma were eligible. After the first two patients to receive protocol therapy developed severe sinusoidal obstruction syndrome (SOS), the trial was re-designed to include an 131 I-MIBG dose escalation (12, 15, and 18 mCi/kg), with a required 10-week gap before Bu/Mel administration. Patients who completed induction chemotherapy were evaluable for assessment of 131 I-MIBG feasibility; those who completed 131 I-MIBG therapy were evaluable for assessment of 131 I-MIBG + Bu/Mel feasibility. RESULTS Fifty-nine of 68 patients (86.8%) who completed induction chemotherapy received 131 I-MIBG. Thirty-seven of 45 patients (82.2%) evaluable for 131 I-MIBG + Bu/Mel received this combination. Among those who received 131 I-MIBG after revision of the study design, one patient per dose level developed severe SOS. Rates of moderate to severe SOS at 12, 15, and 18 mCi/kg were 33.3%, 23.5%, and 25.0%, respectively. There was one toxic death. The 131 I-MIBG and 131 I-MIBG+Bu/Mel feasibility rates at the 15 mCi/kg dose level designated for further study were 96.7% (95% CI: 83.3%-99.4%) and 81.0% (95% CI: 60.0%-92.3%). CONCLUSION This pilot trial demonstrated feasibility and tolerability of administering 131 I-MIBG followed by myeloablative therapy with Bu/Mel to newly diagnosed children with high-risk neuroblastoma in a cooperative group setting, laying the groundwork for a cooperative randomized trial (NCT03126916) testing the addition of 131 I-MIBG during induction therapy.
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Affiliation(s)
- Brian D. Weiss
- Cincinnati Children’s Hospital, University of Cincinnati School of Medicine
| | - Gregory Yanik
- CS Mott Children’s Hospital, University of Michgian School of Medicine
| | - Arlene Naranjo
- Children’s Oncology Group Statistics & Data Center, University of Florida, Gainesville, FL
| | - Fan F Zhang
- Children’s Oncology Group Statistics & Data Center, Monrovia, CA
| | | | - Barry L. Shulkin
- St. Jude Children’s Research Hospital; University of Tennessee Health Science Center
| | | | - Heidi Russell
- Texas Children’s Cancer and Hematology Centers,,Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | - Stephan Grupp
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Luke Pater
- Cincinnati Children’s Hospital, University of Cincinnati School of Medicine
| | - Peter Mattei
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Yael Mosse
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | | | | | | | - Judith G. Villablanca
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California
| | - Roger Giller
- Children’s Hospital Colorado, University of Colorado School of Medicine
| | - Rochelle Bagatell
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Julie R. Park
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Katherine K Matthay
- UCSF Benioff Children’s Hospital, University of California San Francisco School of Medicine, San Francisco, CA
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Pater L, Melchior P, Rübe C, Cooper BT, McAleer MF, Kalapurakal JA, Paulino AC. Wilms tumor. Pediatr Blood Cancer 2021; 68 Suppl 2:e28257. [PMID: 32893998 DOI: 10.1002/pbc.28257] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/22/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 01/03/2023]
Abstract
The objectives for the treatment of Wilms tumor in both the Children's Oncology Group (COG) and the International Society of Paediatric Oncology (SIOP) have focused on improving cure rates and minimizing toxicity by limiting the use of radiation and doxorubicin. Although the timing of surgery is different in COG (upfront surgery) and SIOP (upfront chemotherapy with delayed surgery), both are effective strategies and have the same survival. Fewer patients are treated with radiotherapy in the SIOP trials but with higher doses. The prognostic significance of biological markers such as 1q gain and clinical outcomes with novel radiation techniques such as intensity modulated radiation therapy will be determined in upcoming clinical trials. A closer collaboration between COG and SIOP could help promote research and improve the clinical outcomes of children with Wilms tumor.
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Affiliation(s)
- Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Patrick Melchior
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Benjamin T Cooper
- Department of Radiation Oncology, Perlmutter Cancer Center, New York University School of Medicine, New York, New York
| | - Mary Fran McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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9
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DeWire M, Fuller C, Hummel TR, Chow LML, Salloum R, de Blank P, Pater L, Lawson S, Zhu X, Dexheimer P, Carle AC, Kumar SS, Drissi R, Stevenson CB, Lane A, Breneman J, Witte D, Jones BV, Leach JL, Fouladi M. A phase I/II study of ribociclib following radiation therapy in children with newly diagnosed diffuse intrinsic pontine glioma (DIPG). J Neurooncol 2020; 149:511-522. [PMID: 33034839 DOI: 10.1007/s11060-020-03641-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 08/04/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Cyclin-dependent kinase-retinoblastoma (CDK-RB) pathway is dysregulated in some diffuse intrinsic pontine gliomas (DIPG). We evaluated safety, feasibility, and early efficacy of the CDK4/6-inhibitor ribociclib, administered following radiotherapy in newly-diagnosed DIPG patients. METHODS Following radiotherapy, eligible patients received ribociclib in 28-day cycles (350 mg/m2; 21 days on/7 days off). Feasibility endpoints included tolerability for at least 6 courses, and a less than 2-week delay in restarting therapy after 1 dose reduction. Early efficacy was measured by 1-year and median overall survival (OS). Patient/parent-by-proxy reported outcomes measurement information system (PROMIS) assessments were completed prospectively. RESULTS The study included 10 evaluable patients, 9 DIPG and 1 diffuse midline glioma (DMG)-all 3.7 to 19.8 years of age. The median number of courses was 8 (range 3-14). Three patients required dose reduction for grade-4 neutropenia, and 1 discontinued therapy for hematological toxicity following course 4. The most common grade-3/4 toxicity was myelosuppression. After 2 courses, MRI evaluations in 4 patients revealed increased necrotic volume, associated with new neurological symptoms in 3 patients. The 1-year and median OS for DIPG was 89% and 16.1 months (range 10-30), respectively; the DMG patient died at 6 months post-diagnosis. Five patients donated brain tissue and tumor; 3 were RB+ . CONCLUSIONS Ribociclib administered following radiotherapy is feasible in DIPG and DMG. Increased tumor necrosis may represent a treatment effect. These data warrant further prospective volumetric analyses of tumors with necrosis. Feasibility and stabilization findings support further investigation of ribociclib in combination therapies. TRIAL REGISTRATION NCT02607124.
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Affiliation(s)
- Mariko DeWire
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA.
| | - Christine Fuller
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Trent R Hummel
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
| | - Lionel M L Chow
- Department of Hematology/Oncology, Dayton Children's Hospital, Dayton, OH, USA
| | - Ralph Salloum
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
| | - Peter de Blank
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
| | - Luke Pater
- Department of Radiation Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah Lawson
- Department of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Xiaoting Zhu
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Phil Dexheimer
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adam C Carle
- Department of Pediatrics, Department of Psychology, College of Medicine University of Cincinnati, College of Arts and Sciences University of Cincinnati, Anderson Center Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shiva Senthil Kumar
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
| | - Rachid Drissi
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
| | - Charles B Stevenson
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adam Lane
- Department of Biostatistics, Cincinnati, OH, USA
| | - John Breneman
- Department of Radiation Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David Witte
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Blaise V Jones
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maryam Fouladi
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
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Abstract
Cardiac disease following radiation therapy represents a major consideration in the treatment of a variety of malignancies. Damage to the heart can manifest in a variety of pathologies including ischemic cardiac disease, cardiomyopathy, valvular dysfunction, arrhythmias, and pericarditis. This damage has been shown to directly relate to cardiac radiation dose and to stem from a range of cellular pathways that are often related to fibrosis. The importance of minimizing radiation dose to the heart is especially critical in the pediatric population and when treating disease sites adjacent to the heart. Proton therapy represents a promising approach to minimize dose to normal tissues such as the heart. The cardiac dosimetry reductions due to proton therapy have been demonstrated in multiple cancers and further long-term follow-up will determine the clinical significance of these reductions to cardiac structures. Future approaches using advanced techniques such as FLASH therapy could provide even further benefit by reducing post-radiation fibrosis.
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Affiliation(s)
- Andrew J Frankart
- Department of Radiation Oncology, University of Cincinnati, 234 Goodman Street, ML 0757, Cincinnati, OH, 45267, USA.
| | - Rajaram Nagarajan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, 234 Goodman Street, ML 0757, Cincinnati, OH, 45267, USA
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11
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Medek S, De B, Pater L, Breneman J, Mahajan A, Wolden S, Vatner RE. Practice Patterns Among Radiation Oncologists Treating Pediatric Patients With Proton Craniospinal Irradiation. Pract Radiat Oncol 2019; 9:441-447. [PMID: 31279941 DOI: 10.1016/j.prro.2019.06.012] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/11/2019] [Accepted: 06/21/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Craniospinal irradiation (CSI) is an important component of therapy for many pediatric central nervous system malignancies. Proton therapy is increasingly available and used for minimizing radiation exposure to normal tissues. The absence of an exit dose with proton therapy mandates decisions regarding coverage of the vertebral bodies (VB) in non-skeletally mature patients. Although the contents within the thecal sac represent the true clinical target volume (CTV), some physicians target the entire VB in growing children because of concerns over asymmetrical growth. This study aims to assess current practice patterns regarding VB coverage for pediatric patients undergoing CSI. METHODS AND MATERIALS Pediatric radiation oncologists were identified from the Particle Therapy Co-Operative Group pediatric subcommittee membership or affiliation with US proton centers. Potential participants were contacted by e-mail with a link to an institutional review board-approved, anonymized web-based survey distributed in June 2017 with follow-up in October 2017. The survey used skip logic and included up to 11 questions regarding practice patterns. RESULTS Thirty-three physicians responded to the survey (39%), 5 of which were excluded for lack of recent pediatric proton CSI experience. Of the 28 included responses, 23 physicians sometimes treat the entire VB and 5 physicians report always treating the entire VB. Most common responses regarding anterior CTV expansion for uncertainty were no expansion (n = 9) and 3 to 4 mm (n = 8). Most physicians modify the anterior CTV margin to protect normal structures, most commonly esophagus (n = 15), thyroid (n = 6), heart (n = 5), bowel (n = 4), and pharynx (n = 2). CONCLUSIONS Vertebral body coverage in proton CSI varies among radiation oncologists in respect to target delineation, CTV expansions, and modifications for organs at risk. These data suggest the radiation oncology community may benefit from a standardized approach to pediatric proton-based CSI.
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Affiliation(s)
- Sara Medek
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brian De
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - John Breneman
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Suzanne Wolden
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ralph E Vatner
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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12
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Turpin B, Pressey JG, Nagarajan R, Weiss BD, Trout AT, Gelfand MJ, Pater L, Vatner RE, Breneman JC, Dasgupta R. Sentinel lymph node biopsy in head and neck rhabdomyosarcoma. Pediatr Blood Cancer 2019; 66:e27532. [PMID: 30393936 DOI: 10.1002/pbc.27532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 04/16/2018] [Revised: 09/12/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023]
Abstract
Head and neck rhabdomyosarcoma lymph node staging is challenging due to varied patterns of lymphatic drainage and the suboptimal predictive value of available imaging modalities. Furthermore, regional relapse rates are unacceptably high, and the toxicity of empiric radiation is undesirable in the pediatric and young adult population. In an attempt to improve locoregional control without excess morbidity, we have adopted routine sentinel lymph node biopsy in head and neck rhabdomyosarcoma, which is safe and feasible in pediatric patients. Of six procedures reported here, pathologic findings led to intensification of regional and/or systemic therapy in two patients.
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Affiliation(s)
- Brian Turpin
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joseph G Pressey
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rajaram Nagarajan
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Brian D Weiss
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael J Gelfand
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Ralph E Vatner
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - John C Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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13
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Agresta L, Salloum R, Hummel TR, Ratner N, Mangano FT, Fuller C, McMasters RL, Pater L, Jones BV, Szabo S, Pressey JG. Malignant peripheral nerve sheath tumor: Transformation in a patient with neurofibromatosis type 2. Pediatr Blood Cancer 2019; 66:e27520. [PMID: 30408304 DOI: 10.1002/pbc.27520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/25/2018] [Accepted: 10/01/2018] [Indexed: 11/11/2022]
Abstract
Malignant peripheral nerve sheath tumor (MPNST) is a rare soft-tissue sarcoma with an unfavorable prognosis and limited therapeutic options. MPNSTs can be sporadic, but are often associated with neurofibromatosis (NF) 1 and usually arise from preexisting neurofibromas. MPNSTs in patients with NF2 have been reported in only exceedingly rare cases, and the mechanisms underlying transformation into an MPNST have not been fully elucidated. Here, we describe the clinicopathological and genomic features of a peripheral nerve sheath tumor (PNST), with a primary diagnosis of a neurofibroma, as it transforms into a high-grade MPNST in the context of NF2.
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Affiliation(s)
- Laura Agresta
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ralph Salloum
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Trent R Hummel
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nancy Ratner
- Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Research Foundation, Cincinnati, Ohio
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine Fuller
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Richard L McMasters
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Blaise V Jones
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Sara Szabo
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joseph G Pressey
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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14
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DeWire M, Fuller C, Hummel T, Chow L, Salloum R, Pater L, Drissi R, Lu Q, Stevenson C, Lane A, Breneman J, Witte D, Leach J, Fouladi M. DIPG-73. CLEE011XUS17T (NCT 02607124): A PHASE I/II STUDY OF RIBOCICLIB (LEE011) FOLLOWING RADIATION THERAPY (RT) IN CHILDREN AND YOUNG ADULTS WITH NEWLY DIAGNOSED NON-BIOPSIED DIFFUSE PONTINE GLIOMAS (DIPG) AND RB+ BIOPSIED DIPG AND HIGH GRADE GLIOMAS (HGG). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Trent Hummel
- Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - Lionel Chow
- Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | | | - Luke Pater
- Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | | | - Qing Lu
- Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | | | - Adam Lane
- Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | | | - David Witte
- Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - James Leach
- Cincinnati Children’s Hospital, Cincinnati, OH, USA
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15
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Forster N, Warnick R, Takiar V, Pater L, Breneman J. Debulking surgery of pituitary adenoma as a strategy to facilitate definitive stereotactic radiosurgery. J Neurooncol 2018; 138:335-340. [PMID: 29450811 DOI: 10.1007/s11060-018-2801-0] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/11/2018] [Indexed: 12/01/2022]
Abstract
In patients with pituitary adenomas (PA) who are unable to undergo complete surgical resection, radiation therapy (RT), specifically stereotactic radiosurgery (SRS), results in excellent local control. However, the utility of radiosurgery may be limited by the proximity of the lesion to the optic chiasm (OC). We evaluate the efficacy of debulking surgery in increasing the PA-OC separation to convert patients into SRS candidates. From 2007 to 2015, 31 patients with PA < 2 mm from the OC underwent debulking surgery followed by RT within 2 years of resection. Coronal and sagittal T1-pre- and post-contrast sequences were used to determine PA-OC separation. Time interval between postoperative and pre-radiotherapy MRI scans and type of radiation therapy were analyzed. Functional tumor status, tumor characteristics [cavernous sinus (CS) or suprasellar (SS) involvement, chiasm/nerve encasement (NE)], and presence of ≥ 2 of these characteristics (multiple factors, MF) was also noted. Surgery converted 9 of 31 patients (29%) to SRS candidates. Median time from surgery to pre-RT planning MRI was 8 months (range 2-20). Of the 31 patients initially ineligible for SRS, 6 became eligible immediately after surgery, and another 3 were deemed eligible on follow-up. Mean PA-OC separation was 0.3 mm preoperative, 1.4 mm postoperative, and 2.1 mm at time of SRS (p = 0.002). Preoperative SS, NE, and MF involvement predicted pre-RT separation < 2 mm. Debulking surgery of unresectable pituitary tumors is a successful strategy for converting select radiosurgery-ineligible patients to radiosurgery candidates. Absence of preoperative SS, NE, and MF predicts for successful conversion.
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Affiliation(s)
- Neil Forster
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Ronald Warnick
- Department of Neurosurgery, UC Neuroscience Institute, Cincinnati, OH, USA
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - John Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA.
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Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood with 250-350 cases diagnosed annually in the United States. Biliary tract rhabdomyosarcoma is rare, representing <1% of the RMS cases. Due to its location, resection is clinically challenging, and functional complications exist and persist from biliary obstruction. The anatomical location of this tumor presents both opportunities and challenges for pencil beam scanning proton therapy. Proton therapy offers a dosimetric and clinical advantage by sparing the healthy liver, stomach, contra-lateral kidney and bowel. Motion management and anatomical variations, such as intestinal filling or weight loss, requiring routine dosimetric evaluation and possible adaptive treatment planning, present challenges for the use of proton therapy. By taking advantage of the superior dose distribution of proton radiation, assessing the impact of tumor and anatomy motion, and performing regular dose evaluations, biliary tract RMS is an ideal diagnosis for pencil beam scanning proton therapy.
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Affiliation(s)
- Luke Pater
- Radiation Oncology, University of Cincinnati College of Medicine
| | | | - Anthony Mascia
- Radiation Oncology, University of Cincinnati College of Medicine
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17
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Freese C, Takiar V, Fouladi M, Vatner R, DeWire M, Breneman J, Pater L. (P104) Radiation and Subsequent Reirradiation Outcomes in the Treatment of Diffuse Intrinsic Pontine Glioma and a Systematic Review of the Reirradiation Literature. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.02.200] [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: 10/19/2022]
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18
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DeWire M, Fuller C, Hummel T, Chow LM, Salloum R, Pater L, Drissi R, Lu Q, Stevenson C, Lane A, Breneman J, Witte D, Leach J, Fouladi M. DIPG-27. CLEE011XUS17T (NCT 02607124): A PHASE I/II STUDY OF RIBOCICLIB (LEE011) FOLLOWING RADIATION THERAPY IN CHILDREN WITH NEWLY DIAGNOSED NON-BIOPSIED DIFFUSE PONTINE GLIOMAS (DIPG) AND RB+ BIOPSIED DIPG AND HIGH GRADE GLIOMAS (HGG). Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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Freese C, Takiar V, Fouladi M, DeWire M, Breneman J, Pater L. Radiation and subsequent reirradiation outcomes in the treatment of diffuse intrinsic pontine glioma and a systematic review of the reirradiation literature. Pract Radiat Oncol 2016; 7:86-92. [PMID: 28274399 DOI: 10.1016/j.prro.2016.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Diffuse intrinsic pontine glioma (DIPG) is a devastating pediatric disease, with a median survival of <1 year. Here, we review our institution's DIPG experience over an 8-year interval and perform a systematic review of the literature, specifically evaluating reports of reirradiation (reRT) for DIPG. METHODS AND MATERIALS We retrospectively reviewed the medical records of 26 patients who underwent definitive intensity modulated radiation therapy (IMRT) for DIPG at a single institution between 2007 and 2015. Three of these patients underwent reRT for progressive disease. Clinical endpoints, including progression-free survival and overall survival (OS), were assessed. We then performed a thorough PubMed search of the literature discussing reRT for patients with DIPG. RESULTS Twenty-four of the 26 patients (92%) completed the initial course of radiation (54 Gy in 1.8-Gy fractions using IMRT). Median age at diagnosis was 6.0 years (range, 2.0-26.5). With respect to systemic therapy, 1 (4.2%) received no systemic therapy, 1 (4.2%) received concurrent systemic therapy alone, 4 (16.7%) received adjuvant therapy alone, and 18 (75%) received a combination of concurrent and adjuvant therapy. Median follow-up time was 11 months from the date of initial diagnosis. Median OS for the cohort was 12 months, with a 1-year OS of 51%. The 3 patients who underwent reRT received 20 Gy in 10 daily fractions using IMRT alone with no treatment toxicity noted. CONCLUSIONS Radiation therapy is essential in the definitive management of DIPG. With advances in treatment techniques, it is feasible to reirradiate select patients with progressive disease; however, further research is warranted to optimize dose, delivery, and patient selection in the recurrent/progressive setting. In the future, it may be reasonable to propose more focal delivery of reRT (ie, hypofractionated radiation) in select patients with the goal of reducing treatment time and providing effective palliation.
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Affiliation(s)
- Christopher Freese
- Department of Radiation Oncology, University of Cincinnati Barrett Cancer Center, Cincinnati, Ohio
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati Barrett Cancer Center, Cincinnati, Ohio
| | - Maryam Fouladi
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mariko DeWire
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John Breneman
- Department of Radiation Oncology, University of Cincinnati Barrett Cancer Center, Cincinnati, Ohio
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati Barrett Cancer Center, Cincinnati, Ohio.
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20
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Costello MS, Golub JS, Barrord JV, Pater L, Pensak ML, Samy RN. Cochlear implantation after radiation therapy for acoustic neuroma. J Radiosurg SBRT 2016; 4:69-74. [PMID: 29296428 PMCID: PMC5658841] [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] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/09/2015] [Indexed: 06/07/2023]
Abstract
Neurofibromatosis type 2 (NF-2) represents the complex issue of hearing restoration after treatment for a patient with bilateral acoustic neuromas. This scenario is difficult for skull base teams considering that all treatment options (including observation of tumors) pose a risk to the patient for further or total hearing loss. In this case of a patient with bilateral deafness, restoration options were auditory brainstem or cochlear implantation (CI). The deciding factor for CI was based on the presence of a functioning cochlear nerve and blood supply. Ultimately, treatment with radiation therapy and subsequent CI proved effective as evidenced by dramatic improvement in communication (with lip reading cues) and speech perception on 1-year audiologic testing. Radiosurgery followed by CI may represent a potential emerging option for patients with NF-2.
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Affiliation(s)
- Mark S Costello
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, OH 45267-0528, USA
| | - Justin S Golub
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, OH 45267-0528, USA
- Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, OH 45219, USA
| | - John V Barrord
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, OH 45267-0528, USA
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati (UC) College of Medicine, Cincinnati, OH 45267-0501, USA
- Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, OH 45219, USA
| | - Myles L Pensak
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, OH 45267-0528, USA
- Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, OH 45219, USA
| | - Ravi N Samy
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, OH 45267-0528, USA
- Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, OH 45219, USA
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21
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Kofuji S, Warren M, Sumita K, Hirayama A, Ramkissoon A, Malhotra A, Yoshino H, Pater L, Gozal Y, Gogela S, Kendler A, Wise T, Curry R, Warnick R, Wakimoto H, DasGupta B, Chow L, Soga T, Horbinski C, Sasaki A. CBIO-37DYNAMIC ROLE OF GTP-ENERGY METABOLISM IN GLIOMAGENESIS: DIAGNOSTIC AND THERAPEUTIC APPLICATIONS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov209.37] [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: 11/13/2022] Open
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22
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Haghighi K, Chen G, Sato Y, Fan GC, He S, Kolokathis F, Pater L, Paraskevaidis I, Jones WK, Dorn GW, Kremastinos DT, Kranias EG. A human phospholamban promoter polymorphism in dilated cardiomyopathy alters transcriptional regulation by glucocorticoids. Hum Mutat 2008; 29:640-7. [PMID: 18241046 DOI: 10.1002/humu.20692] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Depressed calcium handling by the sarcoplasmic reticulum (SR) Ca-ATPase and its regulator phospholamban (PLN) is a key characteristic of human and experimental heart failure. Accumulating evidence indicates that increases in the relative levels of PLN to Ca-ATPase in failing hearts and resulting inhibition of Ca sequestration during diastole, impairs contractility. Here, we identified a genetic variant in the PLN promoter region, which increases its expression and may serve as a genetic modifier in dilated cardiomyopathy (DCM). The variant AF177763.1:g.203A>C (at position -36 bp relative to the PLN transcriptional start site) was found only in the heterozygous form in 1 out of 296 normal subjects and in 22 out of 381 cardiomyopathy patients (heart failure at age of 18-44 years, ejection fraction=22+/-9%). In vitro analysis, using luciferase as a reporter gene in rat neonatal cardiomyocytes, indicated that the PLN-variant increased activity by 24% compared to the wild type. Furthermore, the g.203A>C substitution altered the specific sequence of the steroid receptor for the glucocorticoid nuclear receptor (GR)/transcription factor in the PLN promoter, resulting in enhanced binding to the mutated DNA site. These findings suggest that the g.203A>C genetic variant in the human PLN promoter may contribute to depressed contractility and accelerate functional deterioration in heart failure.
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Affiliation(s)
- Kobra Haghighi
- Department of Pharmacology and Cell Biophysics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45267-0575, USA
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23
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Haghighi K, Kolokathis F, Gramolini AO, Waggoner JR, Pater L, Lynch RA, Fan GC, Tsiapras D, Parekh RR, Dorn GW, MacLennan DH, Kremastinos DT, Kranias EG. A mutation in the human phospholamban gene, deleting arginine 14, results in lethal, hereditary cardiomyopathy. Proc Natl Acad Sci U S A 2006; 103:1388-93. [PMID: 16432188 PMCID: PMC1360586 DOI: 10.1073/pnas.0510519103] [Citation(s) in RCA: 268] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The sarcoplasmic reticulum Ca(2+)-cycling proteins are key regulators of cardiac contractility, and alterations in sarcoplasmic reticulum Ca(2+)-cycling properties have been shown to be causal of familial cardiomyopathies. Through genetic screening of dilated cardiomyopathy patients, we identified a previously uncharacterized deletion of arginine 14 (PLN-R14Del) in the coding region of the phospholamban (PLN) gene in a large family with hereditary heart failure. No homozygous individuals were identified. By middle age, heterozygous individuals developed left ventricular dilation, contractile dysfunction, and episodic ventricular arrhythmias, with overt heart failure in some cases. Transgenic mice overexpressing the mutant PLN-R14Del recapitulated human cardiomyopathy exhibiting similar histopathologic abnormalities and premature death. Coexpression of the normal and mutant-PLN in HEK-293 cells resulted in sarcoplasmic reticulum Ca(2+)-ATPase superinhibition. The dominant effect of the PLN-R14Del mutation could not be fully removed, even upon phosphorylation by protein kinase A. Thus, by chronic suppression of sarcoplasmic reticulum Ca(2+)-ATPase activity, the nonreversible superinhibitory function of mutant PLN-R14Del may lead to inherited dilated cardiomyopathy and premature death in both humans and mice.
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Affiliation(s)
- Kobra Haghighi
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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24
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Schmidt AG, Haghighi K, Frank B, Pater L, Dorn GW, Walsh RA, Kranias EG. Polymorphic SERCA2a variants do not account for inter-individual differences in phospholamban-SERCA2a interactions in human heart failure. J Mol Cell Cardiol 2003; 35:867-70. [PMID: 12818578 DOI: 10.1016/s0022-2828(03)00111-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Albrecht G Schmidt
- Department of Pharmacology and Cell Biophysics, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0575, Cincinnati, OH 45267, USA
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25
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Haghighi K, Kolokathis F, Pater L, Lynch RA, Asahi M, Gramolini AO, Fan GC, Tsiapras D, Hahn HS, Adamopoulos S, Liggett SB, Dorn GW, MacLennan DH, Kremastinos DT, Kranias EG. Human phospholamban null results in lethal dilated cardiomyopathy revealing a critical difference between mouse and human. J Clin Invest 2003; 111:869-76. [PMID: 12639993 PMCID: PMC153772 DOI: 10.1172/jci17892] [Citation(s) in RCA: 321] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In human disease and experimental animal models, depressed Ca(2+) handling in failing cardiomyocytes is widely attributed to impaired sarcoplasmic reticulum (SR) function. In mice, disruption of the PLN gene encoding phospholamban (PLN) or expression of dominant-negative PLN mutants enhances SR and cardiac function, but effects of PLN mutations in humans are unknown. Here, a T116G point mutation, substituting a termination codon for Leu-39 (L39stop), was identified in two families with hereditary heart failure. The heterozygous individuals exhibited hypertrophy without diminished contractile performance. Strikingly, both individuals homozygous for L39stop developed dilated cardiomyopathy and heart failure, requiring cardiac transplantation at ages 16 and 27. An over 50% reduction in PLN mRNA and no detectable PLN protein were noted in one explanted heart. The expression of recombinant PLN-L39stop in human embryonic kidney (HEK) 293 cells and adult rat cardiomyocytes showed no PLN inhibition of SR Ca(2+)-ATPase and the virtual absence of stable PLN expression; where PLN was expressed, it was misrouted to the cytosol or plasma membrane. These findings describe a naturally-occurring loss-of-function human PLN mutation (PLN null). In contrast to reported benefits of PLN ablation in mouse heart failure, humans lacking PLN develop lethal dilated cardiomyopathy.
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Affiliation(s)
- Kobra Haghighi
- Department of Pharmacology and Cell Biophysics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45267, USA
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Song Q, Schmidt AG, Hahn HS, Carr AN, Frank B, Pater L, Gerst M, Young K, Hoit BD, McConnell BK, Haghighi K, Seidman CE, Seidman JG, Dorn GW, Kranias EG. Rescue of cardiomyocyte dysfunction by phospholamban ablation does not prevent ventricular failure in genetic hypertrophy. J Clin Invest 2003. [DOI: 10.1172/jci200316738] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Song Q, Schmidt AG, Hahn HS, Carr AN, Frank B, Pater L, Gerst M, Young K, Hoit BD, McConnell BK, Haghighi K, Seidman CE, Seidman JG, Dorn GW, Kranias EG. Rescue of cardiomyocyte dysfunction by phospholamban ablation does not prevent ventricular failure in genetic hypertrophy. J Clin Invest 2003; 111:859-67. [PMID: 12639992 PMCID: PMC153769 DOI: 10.1172/jci16738] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Cardiac hypertrophy, either compensated or decompensated, is associated with cardiomyocyte contractile dysfunction from depressed sarcoplasmic reticulum (SR) Ca(2+) cycling. Normalization of Ca(2+) cycling by ablation or inhibition of the SR inhibitor phospholamban (PLN) has prevented cardiac failure in experimental dilated cardiomyopathy and is a promising therapeutic approach for human heart failure. However, the potential benefits of restoring SR function on primary cardiac hypertrophy, a common antecedent of human heart failure, are unknown. We therefore tested the efficacy of PLN ablation to correct hypertrophy and contractile dysfunction in two well-characterized and highly relevant genetic mouse models of hypertrophy and cardiac failure, Galphaq overexpression and human familial hypertrophic cardiomyopathy mutant myosin binding protein C (MyBP-C(MUT)) expression. In both models, PLN ablation normalized the characteristically prolonged cardiomyocyte Ca(2+) transients and enhanced unloaded fractional shortening with no change in SR Ca(2+) pump content. However, there was no parallel improvement in in vivo cardiac function or hypertrophy in either model. Likewise, the activation of JNK and calcineurin associated with Galphaq overexpression was not affected. Thus, PLN ablation normalized contractility in isolated myocytes, but failed to rescue the cardiomyopathic phenotype elicited by activation of the Galphaq pathway or MyBP-C mutations.
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Affiliation(s)
- Qiujing Song
- Department of Pharmacology and Cell Biophysics, University of Cincinnati Medical Center, Cincinnati, Ohio 45267, USA
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Haghighi K, Kolokathis F, Pater L, Lynch RA, Asahi M, Gramolini AO, Fan GC, Tsiapras D, Hahn HS, Adamopoulos S, Liggett SB, Dorn GW, MacLennan DH, Kremastinos DT, Kranias EG. Human phospholamban null results in lethal dilated cardiomyopathy revealing a critical difference between mouse and human. J Clin Invest 2003. [DOI: 10.1172/jci17892 [doi]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Schmidt AG, Gerst M, Zhai J, Carr AN, Pater L, Kranias EG, Hoit BD. Evaluation of left ventricular diastolic function from spectral and color M-mode Doppler in genetically altered mice. J Am Soc Echocardiogr 2002; 15:1065-73. [PMID: 12373248 DOI: 10.1067/mje.2002.121863] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Doppler indices of transmitral flow are commonly used to assess noninvasively left ventricular (LV) diastolic function in species larger than mice. The objective of our study was to characterize patterns of LV diastolic function in 2 genetically altered mouse models using Doppler- and color M-mode echocardiography. Phospholamban (PLB) reversibly inhibits the sarcoplasmic reticulum Ca(2+) ATPase (SERCA) and is a key regulator of myocardial relaxation. Twelve-week-old PLB knockout mice (PLB/KO) were examined in parallel with age-matched transgenic mice expressing a mutant form of PLB (PLB/N27A) that exhibited superinhibition of SERCA. Transmitral Doppler flow indexes, including isovolumic relaxation time, the ratio of peak early-to-late filling velocities, and deceleration time of peak early transmitral velocity indicate impaired diastolic filling in the PLB/N27A mutants, but improved LV diastolic function in the PLB/KO mice. In addition, a relatively load-independent parameter of LV relaxation measured by color M-mode Doppler, the propagation velocity of early flow into the LV cavity confirmed the observed differences. We conclude that transmitral filling patterns and color M-mode flow propagation velocity reflect changes in myocardial relaxation in mice with genetically altered levels of PLB and may be useful tools to characterize LV diastolic function in other mouse models of disease.
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Affiliation(s)
- Albrecht G Schmidt
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, USA
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