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Wilson JS, Main C, Thorp N, Taylor RE, Majothi S, Kearns PR, English M, Dandapani M, Phillips R, Wheatley K, Pizer B. Correction to: The effectiveness and safety of proton beam radiation therapy in children and young adults with Central Nervous System (CNS) tumours: a systematic review. J Neurooncol 2024; 167:35-37. [PMID: 38441841 PMCID: PMC10978623 DOI: 10.1007/s11060-024-04612-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nicky Thorp
- The Clatterbridge Cancer Centre, Liverpool, UK
- The Christie Hospital Foundation Trust Proton Beam Therapy Centre, Manchester, UK
| | | | - Saimma Majothi
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin English
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Madhumita Dandapani
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- University of Liverpool, Liverpool, UK
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Wilson JS, Main C, Thorp N, Taylor RE, Majothi S, Kearns PR, English M, Dandapani M, Phillips R, Wheatley K, Pizer B. The effectiveness and safety of proton beam radiation therapy in children and young adults with Central Nervous System (CNS) tumours: a systematic review. J Neurooncol 2024; 167:1-34. [PMID: 38294638 PMCID: PMC10978619 DOI: 10.1007/s11060-023-04510-4] [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: 09/12/2023] [Accepted: 11/14/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Central nervous system (CNS) tumours account for around 25% of childhood neoplasms. With multi-modal therapy, 5-year survival is at around 75% in the UK. Conventional photon radiotherapy has made significant contributions to survival, but can be associated with long-term side effects. Proton beam radiotherapy (PBT) reduces the volume of irradiated tissue outside the tumour target volume which may potentially reduce toxicity. Our aim was to assess the effectiveness and safety of PBT and make recommendations for future research for this evolving treatment. METHODS A systematic review assessing the effects of PBT for treating CNS tumours in children/young adults was undertaken using methods recommended by Cochrane and reported using PRISMA guidelines. Any study design was included where clinical and toxicity outcomes were reported. Searches were to May 2021, with a narrative synthesis employed. RESULTS Thirty-one case series studies involving 1731 patients from 10 PBT centres were included. Eleven studies involved children with medulloblastoma / primitive neuroectodermal tumours (n = 712), five ependymoma (n = 398), four atypical teratoid/rhabdoid tumour (n = 72), six craniopharyngioma (n = 272), three low-grade gliomas (n = 233), one germ cell tumours (n = 22) and one pineoblastoma (n = 22). Clinical outcomes were the most frequently reported with overall survival values ranging from 100 to 28% depending on the tumour type. Endocrine outcomes were the most frequently reported toxicity outcomes with quality of life the least reported. CONCLUSIONS This review highlights areas of uncertainty in this research area. A well-defined, well-funded research agenda is needed to best maximise the potential of PBT. SYSTEMATIC REVIEW REGISTRATION PROSPERO-CRD42016036802.
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Affiliation(s)
- Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nicky Thorp
- The Clatterbridge Cancer Centre, Liverpool, UK
- The Christie Hospital Foundation Trust Proton Beam Therapy Centre, Manchester, UK
| | | | - Saimma Majothi
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin English
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Madhumita Dandapani
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- University of Liverpool, Liverpool, UK
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Apps J, Gagen R, Neumann E, Solanki G, English M. A 13-year patient journey of infant giant clival chordoma: case report and literature review. Childs Nerv Syst 2023; 39:1077-1081. [PMID: 36414866 PMCID: PMC10159969 DOI: 10.1007/s00381-022-05749-4] [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: 04/06/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022]
Abstract
Chordomas are rare malignant bone tumours that develop from the ectopic remnants of the embryonic notochord. In contrast to adults, the majority in children under 16 present intra-cranially (63%). In 2006, we reported the youngest case of a large clival chordoma, a 15-week old baby, the second case to present without skull base involvement and the fourth case of chordoma in a patient with tuberous sclerosis (TS) Kombogiorgas (Childs Nerv Syst 22(10):1369-1374, 2006). In this report, we provide an update on this patient's journey through a range of therapeutic options and summarize an update of the literature, since 2006, for this patient group.
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Affiliation(s)
- J Apps
- Department of Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Department of Neurosurgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Cancer Research Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - R Gagen
- Department of Neurosurgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Radiology Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - E Neumann
- Department of Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Department of Neurosurgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - G Solanki
- Cancer Research Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - M English
- Department of Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
- Department of Neurosurgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
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Caperchione C, English M, Sharp P, Wallace L, Harris D, Ashton J. A family-based approach examining perceptions of a TRYathlon series on children’s health and development. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.025] [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: 11/17/2022]
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Green K, Panagopoulou P, D'Arco F, O'Hare P, Bowman R, Walters B, Dahl C, Jorgensen M, Patel P, Slater O, Ahmed R, Bailey S, Carceller F, Collins R, Corley E, English M, Howells L, Kamal A, Kilday JP, Lowis S, Lumb B, Pace E, Picton S, Pizer B, Shafiq A, Uzunova L, Wayman H, Wilson S, Hargrave D, Opocher E. A Nationwide Evaluation of Bevacizumab-based Treatments in Paediatric Low-Grade Glioma in the UK: Safety. Efficacy, Visual Morbidity and Outcomes. Neuro Oncol 2022; 25:774-785. [PMID: 36239316 PMCID: PMC10076941 DOI: 10.1093/neuonc/noac223] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bevacizumab is increasingly used in children with Paediatric Low-Grade Glioma (PLGG) despite limited evidence. A nationwide UK service evaluation was conducted to provide larger cohort 'real life' safety and efficacy data including functional visual outcomes. METHODS Children receiving Bevacizumab-based treatments (BBT) for PLGG (2009-2020) from 11 centres were included. Standardised neuro-radiological (RANO-LGG) and visual (logMAR visual acuity) criteria were used to assess clinical-radiological correlation, survival outcomes and multivariate prognostic analysis. RESULTS Eighty-eight children with PLGG received BBT either as 3 rd line with Irinotecan (85%) or alongside 1 st/2 nd line chemotherapies (15%). Toxicity was limited and minimal. Partial response (PR, 40%), stable disease (SD, 49%), and progressive disease (PD, 11%) were seen during BBT. However, 65% progressed at 8 months (median) from BBT cessation, leading to a radiology-based 3yr-progression-free survival (PFS) of 29%. Diencephalic syndrome (p= 0.03) was associated with adverse PFS. Pre-existing visual morbidity included unilateral (25%) or bilateral (11%) blindness. Improvement (29%) or stabilisation (49%) of visual acuity were achieved, more often in patients' best eyes. Vision deteriorated during BBT in 14 (22%), with 3-year visual-PFS of 53%; more often in patients' worst eyes. A superior visual outcome (p=0.023) was seen in Neurofibromatosis type 1-associated Optic Pathway Glioma (OPG). Concordance between visual and radiological responses was 36%; optimised to 48% using only best eye responses. CONCLUSIONS BBTs provide effective short-term PLGG control and delay further progression, with a better sustained visual (best >worst eye) than radiological response. Further research could optimise the role of BBTs towards a potentially sight-saving strategy in OPG.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Olga Slater
- Great Ormond Street Hospital London, United Kingdom
| | | | - Simon Bailey
- Great North Children's Hospital Newcastle, United Kingdom
| | | | | | | | | | | | - Ahmed Kamal
- Birmingham Children's Hospital, United Kingdom
| | - John-Paul Kilday
- Royal Manchester Children's Hospital, United Kingdom.,The Centre for Paediatric, Teenage and Young Adult Cancer Sciences, The University of Manchester, United Kingdom
| | | | - Blanche Lumb
- Noah's Ark Children's Hospital for Wales, United Kingdom
| | - Erika Pace
- The Royal Marsden Hospital London, United Kingdom
| | | | - Barry Pizer
- Alder Hey Children's Hospital Liverpool, United Kingdom
| | - Ayad Shafiq
- Great North Children's Hospital Newcastle, United Kingdom
| | - Lena Uzunova
- Noah's Ark Children's Hospital for Wales, United Kingdom
| | | | | | | | - Enrico Opocher
- Great Ormond Street Hospital London, United Kingdom.,Padua University Hospital, Padua, Italy
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Geurten C, Pavon-Mengual M, Lo WB, Bowen C, Gagen R, Stirling H, Neuling K, Painter SL, Williams J, Carr B, English M. Optic Nerve Germinoma and Transient Spontaneous Regression-More Than Meets the Eye. J Pediatr Hematol Oncol 2022; 44:255-260. [PMID: 34654758 DOI: 10.1097/mph.0000000000002340] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
Infiltration of the optic pathway by germ cell tumors is exceptional and can lead to confusion with glioma or inflammatory conditions. We present the case of a 14-year-old girl with an optic nerve germinoma extending to the hypothalamus and manifesting as panhypopituitarism and visual loss. The patient experienced spontaneous regression of the lesion followed by secondary deterioration requiring treatment. Four other cases of spontaneously regressing intracranial germinoma followed by regrowth have been reported in the literature. This report highlights the importance of clinical and radiologic monitoring of intracranial germinoma, even in the event of initial spontaneous improvement.
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Affiliation(s)
- Claire Geurten
- Departments of Paediatric Haematology/Oncology.,Department of Paediatric Haematology/Oncology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | | | | | | | | | | | | | | | - Jerald Williams
- Ophthalmology.,Department of Ophthalmology, University Hospital Coventry and Warwickshire, Coventry, United Kingdom
| | - Bryony Carr
- Neurophysiology, Birmingham Women and Children's NHS Foundation Trust, Birmingham
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Afshari FT, English M, Lo WB. Tectal plate gliomas masquerading as idiopathic aqueduct stenosis. World Neurosurg 2022; 165:92-94. [PMID: 35752420 DOI: 10.1016/j.wneu.2022.06.063] [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] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
Aqueduct stenosis is a recognised cause of obstructive hydrocephalus in children and can be treated effectively with endoscopic third ventriculostomy. Magnetic resonance imaging pre-operatively is often diagnostic of the cause of aqueduct stenosis. We describe two paediatric cases with obstructive hydrocephalus secondary to a working diagnosis of idiopathic aqueduct stenosis. Following successful endoscopic third ventriculostomy, repeat magnetic resonance brain imaging revealed tectal plate glioma as the primary cause of obstruction. We believe these two reported cases demonstrate a previously unreported phenomenon whereby concealed tectal gliomas presenting with hydrocephalus are only unmasked following relief of hydrocephalus and decompression and normalisation of the ventricular system. We aim to raise awareness about this unusual phenomenon and recommend routine post-operative interval imaging following endoscopic third ventriculostomy, to avoid missing underlying pathology masquerading as aqueduct stenosis.
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Affiliation(s)
- Fardad T Afshari
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH.
| | - Martin English
- Department of Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH
| | - William B Lo
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH
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Rodrigues B, Adamski J, English M, Curry H, Solanki G, Peet A, Apps J. RARE-11. 60 years single centre experience of craniopharyngioma management. Neuro Oncol 2022. [PMCID: PMC9164632 DOI: 10.1093/neuonc/noac079.036] [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: 11/14/2022] Open
Abstract
Abstract
Adamantinomatous craniopharyngiomas are challenging intracranial tumours associated with significant morbidity. Management includes surgery and radiotherapy, with a shift towards more conservative surgery in recent years, aimed at preserving hypothalamic function. The West Midlands Regional Children’s Tumour Registry collects detailed clinical, pathological and follow up information on patients treated within the region from 1957. 52 cases (26 male, 26 female) of craniopharyngioma treated at Birmingham Children’s Hospital 1957-2018, were identified, with further clinical details obtained from patient records, where available. Visual symptoms were the commonest presenting feature (63%), followed by headache (48%), vomiting (31%), neurological symptoms (31%) and features of endocrine disorders (21%) with a median symptom duration of 6 months (range <1-24). Initial management was with gross total resection (GTR) in 14 patients, subtotal resection in 22 patients and subtotal resection with adjuvant radiotherapy in seven patients. Two patients received radiotherapy without resection, and five patients underwent cystic drainage procedures alone. Two patients initially underwent shunt insertion alone, but received radiotherapy at progression. 30 (58%) patients underwent relapse/progression, with a median time to progression of 1.2 years (range 0.2-6.3). 15 had further surgery. Radiotherapy was used in 14/15 patients who had not previously received radiotherapy, with the other undergoing a GTR. To date 10 patients have died, nine from tumour related reasons and one from pulmonary embolism. Where data was available at follow up, all patients had at least one endocrinopathy, with 38/45 patients having diabetes insipidus. Hypothalamic obesity was identified in 14/36 (39%) patients with sufficient records, with this more common in those undergoing GTR (7/9 (78%)) compared to other surgical procedures (7/27)(26%)(p<0.05). Three patients have developed neurovascular complications and three fatty liver disease. This experience is consistent with the literature and supports the increasing usage of hypothalamic sparing surgical management.
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Affiliation(s)
- Beryl Rodrigues
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
| | - Jenny Adamski
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
| | - Martin English
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
| | - Helen Curry
- West Midlands Regional Children's Tumour Registry , Birmingham , United Kingdom
| | - Guirish Solanki
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
| | - Andrew Peet
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
- University of Birmingham , Birmingham , United Kingdom
| | - John Apps
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
- University of Birmingham , Birmingham , United Kingdom
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Green K, Panagopoulou P, D’Arco F, O'Hare P, Bowman R, Walters B, Dahl C, Jorgensen M, Patel P, Slater O, Ahmed R, Bailey S, Carceller F, Collins R, Corley E, English M, Hayden J, Howells L, Kamal A, Kilday JP, Lowis S, Lumb B, Micic T, Mitra D, Pace E, Picton S, Pizer B, Shafiq A, Uzunova L, Wilson S, Wayman H, Hargrave D, Opocher E. LGG-09. A Nationwide Service Evaluation of Safety, Radiologic and Visual Outcome Refining Bevacizumab-based Treatments in Children with Progressive Low-Grade Glioma. Neuro Oncol 2022. [PMCID: PMC9164923 DOI: 10.1093/neuonc/noac079.325] [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: 11/15/2022] Open
Abstract
Abstract
INTRODUCTION: Bevacizumab/Irinotecan is currently 3rd-line treatment in the UK for progressive Paediatric Low-Grade Glioma (PLGG) based on limited evidence. A nationwide service evaluation was conducted to review its safety and efficacy amongst a larger cohort.
METHODS: Data from children with PLGG receiving Bevacizumab-based Treatments (BBT) from 11 UK Centres (2009-2020) were reviewed. Radiological and visual outcomes were based on standardized measurements. Clinical-radiological correlation was investigated. Time to progression from BBT stop, progression free-survival (PFS) curves and multivariate analysis of prognostic factors (p 0.05) were performed.
RESULTS: 88 children with PLGG (88% OPG, 24% NF1) had BBT for radiological (43%), visual (20%) or combined (27%) progression, after 40 months (median) from diagnosis. Amongst OPG cases, visual acuity (VA) per eye (better/worse) before BBT was logMAR 0.0-0.3 (23/7) 0.3 - 1.0 (27/20), > 1.0 (14/18) and LP/NLP (8/27), with 19/8 children respectively blind (LP/NLP) in one or both eyes. Bevacizumab 10 mg/kg every 14 days (median 24 doses) was given as 3rd line+ with Irinotecan (85%) or alongside 1st/2nd line chemo (15%) leading to remarkable radiological (88%) and visual (74%) responses (stable or improved) within 3-6 months, with limited toxicity. 12% progressed on treatment, and 8% died unrelated to BBT. After initial response 65% progressed at a median of 8 months (4 - 23) after BBT, resulting in 3-year-all-causes-PFS of 16% and 3-yr-visual-PFS of 45% from start of BBT. Visual concordance with MRI was poor (36%) but increases (47%) when better-eye determines visual outcome. Lack of NF1 and diencephalic syndrome (DS) at presentation were independent negative prognostic factors for PFS.
CONCLUSIONS: A remarkable but transient effect of BBT has been confirmed. Visual > radiological responses can be sustained after BBT. Variations in current BBT strategies justifies further research, including the potential upfront use alongside conventional first-line chemotherapy as sight-saving strategy.
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Affiliation(s)
| | - Paraskevi Panagopoulou
- Great Ormond Street Hospital , London , United Kingdom
- Aristotle University of Thessaloniki Medical School , Thessaloniki , Greece
| | | | - Patricia O'Hare
- Children's Hospital Belfast , Belfast , United Kingdom
- Great Ormond Street Hospital , London , United Kingdom
| | | | | | | | | | - Pritesh Patel
- Great Ormond Street Hospital , London , United Kingdom
| | - Olga Slater
- Great Ormond Street Hospital , London , United Kingdom
| | - Rehana Ahmed
- Nottingham Children's Hospital , Nottingham , United Kingdom
| | - Simon Bailey
- Great North Children's Hospital , Newcastle , United Kingdom
| | | | | | | | - Martin English
- Birmingham Children's Hospital , Birmingham , United Kingdom
| | - James Hayden
- Alderhey Children's Hospital , Liverpool , United Kingdom
| | - Lisa Howells
- Alderhey Children's Hospital , Liverpool , United Kingdom
| | - Ahmed Kamal
- Birmingham Children's Hospital , Birmingham , United Kingdom
| | - John Paul Kilday
- Royal Manchester Children's Hospital , Manchester , United Kingdom
| | - Stephen Lowis
- Bristol Children's Hospital , Bristol , United Kingdom
| | - Blanche Lumb
- Noah's Ark Children's Hospital Wales , Cardiff , United Kingdom
| | - Thomas Micic
- Noah's Ark Children's Hospital Wales , Cardiff , United Kingdom
| | - Dip Mitra
- Great North Children's Hospital , Newcastle , United Kingdom
| | - Erika Pace
- Royal Marsden Hospital , London , United Kingdom
| | - Susan Picton
- Leeds Children's Hospital , Leeds , United Kingdom
| | - Barry Pizer
- Alderhey Children's Hospital , Liverpool , United Kingdom
| | - Ayad Shafiq
- Great North Children's Hospit , Newcastle , United Kingdom
| | - Lena Uzunova
- Noah's Ark Children's Hospital Wales , Cardiff , United Kingdom
| | - Shaun Wilson
- John Radcliffe Hospital , Oxford , United Kingdom
| | - Harriet Wayman
- Royal Manchester Children's Hospital , Manchester , United Kingdom
| | | | - Enrico Opocher
- Great Ormond Street Hospital , London , United Kingdom
- Padua University Hospital , Padua , Italy
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Apps J, Peet A, English M, Adamski J. OTHR-20. Precision neuro-oncology in the real world. Opportunity and challenges from a UK Oncology Centre. Neuro Oncol 2022. [PMCID: PMC9164987 DOI: 10.1093/neuonc/noac079.559] [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: 11/13/2022] Open
Abstract
Abstract
The last five years has shown advances in the molecular classification of brain tumour, molecular profiling techniques and an increased use of targeted therapies. We reviewed the molecular analysis pathways and use of targeted agents at Birmingham Children’s Hospital (BCH), a large (~55 new cases/year) neuro-oncology centre, between 2016-2021. Having previously been analysed locally by limited directed immuno-histochemical stains and referral for specific genetic tests, tissue is now referred for a range of second histopathological opinions and in depth molecular classification, via methylation array, panel sequencing, RNA fusion analysis, and whole genome sequencing. These are accessed through different evolving pathways and consent processes, including referral to other centres, national reference laboratories, clinical studies, and local genetics laboratories with links to national sequencing infrastructures. Different routes result in different reporting structures, timescales and with varying levels of interpretation, often without adequate access to clinical information and context. 21 patients were treated on five targeted agent clinical trials (Afatanib (n=6), Biomede (n=3), eSmart(n=1), PARC (n=7), Vinilo (n=5)), with one patient on both Afatanib and PARC trials. A further two patients visited other centres for trials. Eight patients received MAPK pathway inhibitors through compassionate access pathways, with benefit, including radiological response, in four. Cardiac toxicity was observed in three and retinal oedema in one. Two patients received immune checkpoint inhibition, with rapid fatal enlargement, either progression or pseudo-progression, in one case. These rapid changes in diagnostic and management options offer new opportunities for patients, but bring challenges to the delivery of neuro-oncology services, including the logistics of sample, report, clinical trial, compassionate access management and the increased multi-specialist support required for monitoring and management of toxicities. Integration of targeted agents into the appropriate part of a patient’s treatment strategy requires skilled interpretation of the benefits compared to conventional therapies.
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Affiliation(s)
- John Apps
- Birmingham Women's and Children's Hospital , Birmingham , United Kingdom
- University of Birmingham , Bimingham , United Kingdom
| | - Andrew Peet
- Birmingham Women's and Children's Hospital , Birmingham , United Kingdom
- University of Birmingham , Bimingham , United Kingdom
| | - Martin English
- Birmingham Women's and Children's Hospital , Birmingham , United Kingdom
| | - Jenny Adamski
- Birmingham Women's and Children's Hospital , Birmingham , United Kingdom
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Leblond P, Massimino M, English M, Ritzmann TA, Gandola L, Calaminus G, Thomas S, Pérol D, Gautier J, Grundy RG, Frappaz D. Toward Improved Diagnosis Accuracy and Treatment of Children, Adolescents, and Young Adults With Ependymoma: The International SIOP Ependymoma II Protocol. Front Neurol 2022; 13:887544. [PMID: 35720069 PMCID: PMC9201444 DOI: 10.3389/fneur.2022.887544] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
Background The clinical management of ependymoma in childhood and adolescence is complex and the clinicobiopathological correlates of outcome remain poorly understood. This international SIOP Ependymoma II (SIOP EPII) trial aims to improve the outcome of patients with ependymoma. Methods SIOP EPII includes any patient <22 years at diagnosis with ependymoma, stratified by age, tumor location, and outcome of the initial surgery. Centralized pathology and imaging is required for diagnosis confirmation. SIOP EPII included three randomized studies according to age, postoperative residue, and suitability to receive radiotherapy. Patients ineligible for interventional strata are followed-up in an observational study. The staging phase aims to determine if central neurosurgical and radiological postoperative MRI reviews increase the resection rate. Patients ≥12 months with (i) no residual disease are randomly assigned in a phase III trial to evaluate the efficacy of post-radiation 16-week chemotherapy (VEC + CDDP) on PFS (stratum I); (ii) centrally confirmed measurable inoperable residual disease are allocated to randomized frontline chemotherapy phase II study (VEC vs. VEC + high-dose methotrexate) and considered for a second-look surgery (stratum II). If second-look surgery is not feasible or tumor residuum remains, patients receive 8 Gy-boost radiotherapy after conformal radiotherapy (phase I). (iii) Patients < 12 months (18 months in the UK) or not eligible to receive radiotherapy are randomized in a phase II study to receive chemotherapy (alternated myelosuppressive and nonmyelosuppressive chemotherapy), with or without valproate (stratum III). To overcome the limitations encountered in the preliminary conclusions of the ACNS-0831 study, a SIOP EPII dedicated on-study amendment has been planned to definitively conclude the relevance of maintenance chemotherapy in stratum I. Secondary outcomes include overall survival, quality of life, neuropsychological and neuroendocrine outcomes, safety, and identification of key prognostic biomarkers (BIOMECA). Clinical Trial Registration ClinicalTrials.gov, identifier: NCT02265770.
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Affiliation(s)
- Pierre Leblond
- Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martin English
- Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Timothy A. Ritzmann
- Children's Brain Tumour Research Centre, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital of Bonn, Bonn, Germany
| | - Sophie Thomas
- Children's Brain Tumour Research Centre, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
- Department of Paediatric Neuropsychology, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, United Kingdom
| | - David Pérol
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Julien Gautier
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Richard G. Grundy
- Children's Brain Tumour Research Centre, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - Didier Frappaz
- Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
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12
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Murray MJ, Moleron R, Adamski J, English M, Burke GAA, Cross J, Ajithkumar T, Stoneham S, Nicholson JC. Vinblastine monotherapy induction prior to radiotherapy for patients with intracranial germinoma during the COVID-19 pandemic. Pediatr Blood Cancer 2022; 69:e29359. [PMID: 34520101 PMCID: PMC8662027 DOI: 10.1002/pbc.29359] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with localized intracranial germinoma have excellent survival. Reducing treatment burden and long-term sequelae is a priority. Intensive inpatient chemotherapy (e.g., carboPEI = carboplatin/etoposide/ifosfamide) has been effectively employed to reduce radiotherapy treatment volume/dose. Outpatient-based carboplatin monotherapy is associated with excellent outcomes in metastatic testicular seminoma (an identical pathology), and successful vinblastine monotherapy induction (with 77% tumor volume reduction after just two weekly vinblastine doses) has recently been reported in an intracranial germinoma patient. METHODS Adapted UK guidelines for germ cell tumor management were distributed during the COVID-19 pandemic, including nonstandard treatment options to reduce hospital visits and/or admissions. This included vinblastine monotherapy for intracranial germinoma (6 mg/m2 intravenously, or 4 mg/m2 for moderate count suppression, delivered weekly). We describe two such patients treated using this approach. RESULTS A 30-year-old male with a localized pineal tumor received 12-week vinblastine induction, with >60% volume reduction, prior to definitive radiotherapy. A 12-year-old female with a metastatic suprasellar tumor and progression at all sites of disease whilst awaiting proton radiotherapy received two vinblastine doses with good early response, including 36% primary tumor volume reduction. The patients tolerated vinblastine well. CONCLUSION Patients with intracranial germinoma have excellent outcomes, and reduction of late effects remains a priority. The description of vinblastine monotherapy in these intracranial germinoma patients warrants further exploration.
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Affiliation(s)
- Matthew J. Murray
- Department of PathologyUniversity of CambridgeCambridgeUK,Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Rafael Moleron
- Department of Clinical OncologyAberdeen Royal InfirmaryAberdeenUK
| | - Jennifer Adamski
- Department of Paediatric Haematology and OncologyBirmingham Children's HospitalBirminghamUK
| | - Martin English
- Department of Paediatric Haematology and OncologyBirmingham Children's HospitalBirminghamUK
| | - G. A. Amos Burke
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Justin Cross
- Department of RadiologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Thankamma Ajithkumar
- Department of OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Sara Stoneham
- Department of Paediatric and TYA OncologyUniversity College Hospital LondonLondonUK
| | - James C. Nicholson
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
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13
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Caperchione C, Diamond S, English M, Wallace L. The impact of physical activity and sport programs on mental, social and emotional wellbeing of young Aboriginal and Torres Strait Islander people: A systematic review. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.167] [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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14
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Tyldesley-Marshall N, Greenfield S, Neilson SJ, English M, Adamski J, Peet A. The role of Magnetic Resonance Images (MRIs) in coping for patients with brain tumours and their parents: a qualitative study. BMC Cancer 2021; 21:1013. [PMID: 34507545 PMCID: PMC8431927 DOI: 10.1186/s12885-021-08673-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND When children and young people (CYP) are diagnosed with a brain tumour, Magnetic Resonance Imaging (MRI) is key to the clinical management of this condition. This can produce hundreds, and often thousands, of Magnetic Resonance Images (MRIs). METHODS Semi-structured interviews were undertaken with 14 families (15 parents and 8 patients), and analysed using Grounded Theory. Analysis was supported by the Framework Method. RESULTS Although the focus of the research was whether paediatric patients and their families find viewing MRIs beneficial, all patients and parents discussed difficult times during the illness and using various strategies to cope. This article explores the identified coping strategies that involved MRIs, and the role that MRIs can play in coping. Coping strategies were classified under the aim of the strategy when used: 'Normalising'; 'Maintaining hope and a sense of the future'; 'Dealing with an uncertain future'; and 'Seeking Support'. CONCLUSIONS Coping and finding ways to cope are clearly used by patients and their families and are something that they wish to discuss, as they were raised in conversations that were not necessarily about coping. This suggests clinicians should always allow time and space (in appointments, consultations, or impromptu conversations on the ward) for patient families to discuss ways of coping. MRIs were found to be used in various ways: to maintain or adapt normal; maintain hope and a sense of the future; deal with an uncertain future; and seek support from others. Clinicians should recognise the potential for MRIs to aid coping and if appropriate, suggest that families take copies of scans (MRIs) home. Professional coaches or counsellors may also find MRIs beneficial as a way to remind families that the child is in a more stable or 'better' place than they have been previously.
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Affiliation(s)
- Natalie Tyldesley-Marshall
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, B15 2TT UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
- Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
| | - Susan J. Neilson
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Martin English
- Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Jenny Adamski
- Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Andrew Peet
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, B15 2TT UK
- Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
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15
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Pavon-Mengual M, Curry H, Saraff V, Mohamed Z, Benghiat H, Ford D, Peet A, Adamski J, English M. MBCL-52. ENDOCRINE PROFILE AFTER MEDULLOBLASTOMA TREATMENT. Neuro Oncol 2020. [PMCID: PMC7715513 DOI: 10.1093/neuonc/noaa222.521] [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: 11/22/2022] Open
Abstract
BACKGROUND Treatment of medulloblastoma has evolved substantially with more chemotherapy, risk-adapted dosing of radiotherapy (RT) and new RT techniques. We present the endocrine profile for our patients treated over a 20-year period. METHODS The charts of patients treated for medulloblastoma between 1/1/00 and 31/12/19 were reviewed. 105 were available. Group 1 received chemotherapy alone, Group 2 received 23.4 Gy whole CNS RT with a posterior fossa (PF) boost to 54 Gy, Group 3 received > 35 Gy whole CNS RT with PF boost to 54–59 Gy, Group 4 received PF RT to 54 Gy. All received chemotherapy according to national guidelines or clinical trials relevant at the time. RESULTS Group 1 (M:F 11:6, 7 survivors mean age 2 years range 1–7) had no endocrinopathies. At 5 years from diagnosis Group 2 (M:F 15:13) and Group 3 (M:F 35:14) had the following % RESULTS Survival 77:61; Growth Hormone deficiency 92:100; Thyroid deficiency 75:81; ACTH deficiency 42:33. Girls were more likely to need sex hormone replacement than boys. Group 4 (M:F 7:5 mean age 2) were all treated in the first decade. 3 survivors, one GH deficiency, one thyroxine deficiency, one both. CONCLUSIONS There is a trend to earlier endocrinopathies in the group 3 vs group 2 patients, but it does not reach statistical significance. Girls are more likely to need sex hormone replacement than boys. This investigation provides a contemporary profile of endocrinopathy after treatment for medulloblastoma that can be used for future comparisons.
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Affiliation(s)
- Miriam Pavon-Mengual
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Helen Curry
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Vrinda Saraff
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Zainaba Mohamed
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Helen Benghiat
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Daniel Ford
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Peet
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Jenny Adamski
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Martin English
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
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Macarthur DC, Mallucci C, Kamaly-Asl I, Goodden J, Storer LCD, Chapman RJ, Kilday JP, English M, Jaspan T, Chattopadhyay A, Dineen RA, Avula S, Stivaros S, Grundy R. EPEN-24. SIOP EPENDYMOMA II: CENTRAL EPENDYMOMA MANAGEMENT ADVISORY GROUP – THE UK EXPERIENCE. Neuro Oncol 2020. [PMCID: PMC7715772 DOI: 10.1093/neuonc/noaa222.161] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Paediatric Ependymoma is the second most common malignant brain tumour of childhood with approximately 50% of cases recurring. It has been described as a “surgical” disease since patients who have undergone a gross total surgical resection (GTR) have a better prognosis than those who have a subtotal resection (STR). Analysis of the UKCCSG/SIOP 1992 04 clinical trial has shown that only 49% of cases had a GTR, with 5-year survival rates for STR of 22–47% and GTR of 67–80%. As part of the SIOP II Ependymoma trial the UK established a panel of experts in the treatment of Ependymoma from Neuro-oncology, Neuro-radiology and Neuro-surgery. Meeting weekly, cases are discussed to provide a consensus on radiological review, ensuring central pathological review, trial stratification and whether further surgery should be advocated on any particular case. Evaluation of the first 68 UK patients has shown a GTR in 47/68 (69%) of patients and STR in 21/68 (31%) of patients. Following discussion at EMAG it was felt that 9/21 (43%) STR patients could be offered early second look surgery. Following this 2nd look surgery the number of cases with a GTR increased to 56/68 (82%). There has been a clear increase in the number of patients for whom a GTR has been achieved following discussion at EMAG and prior to them moving forwards with their oncological treatment. This can only have beneficial effects in decreasing their risk of tumour recurrence or CSF dissemination and also in reducing the target volume for radiotherapy.
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Affiliation(s)
- Donald C Macarthur
- Nottingham University Hospitals, Nottingham, Nottinghamshire, United Kingdom
- Birmingham Children’s Hospital, Birmingham, West Midlands, United Kingdom
| | - Conor Mallucci
- Alder Hey Children’s Hospital, Liverpool, Merseyside, United Kingdom
| | - Ian Kamaly-Asl
- Royal Manchester Children’s Hospital, Manchester, Lancashire, United Kingdom
| | - John Goodden
- Leeds Teaching Hospitals, Leeds, Yorkshire, United Kingdom
| | - Lisa C D Storer
- School of Medicine, University of Nottingham, Nottinghamshire, United Kingdom
| | - Rebecca J Chapman
- School of Medicine, University of Nottingham, Nottinghamshire, United Kingdom
| | - J-P Kilday
- Royal Manchester Children’s Hospital, Manchester, Lancashire, United Kingdom
| | - Martin English
- Birmingham Children’s Hospital, Birmingham, West Midlands, United Kingdom
| | - Tim Jaspan
- Nottingham University Hospitals, Nottingham, Nottinghamshire, United Kingdom
| | | | - Rob A Dineen
- Nottingham University Hospitals, Nottingham, Nottinghamshire, United Kingdom
- Birmingham Children’s Hospital, Birmingham, West Midlands, United Kingdom
| | - Shivaram Avula
- Alder Hey Children’s Hospital, Liverpool, Merseyside, United Kingdom
| | - Stavros Stivaros
- Royal Manchester Children’s Hospital, Manchester, Lancashire, United Kingdom
| | - Richard Grundy
- Nottingham University Hospitals, Nottingham, Nottinghamshire, United Kingdom
- Birmingham Children’s Hospital, Birmingham, West Midlands, United Kingdom
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Apps J, Neumann E, Afshari F, Solanki G, English M. RARE-46. A THIRTEEN YEAR PATIENT JOURNEY OF INFANT GIANT CLIVAL CHORDOMA: CASE REPORT AND LITERATURE REVIEW. Neuro Oncol 2020. [PMCID: PMC7715812 DOI: 10.1093/neuonc/noaa222.756] [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: 11/19/2022] Open
Abstract
In 2006 we reported the youngest case of a large clival chordoma, a 15-week old baby, the second case to present without skull base involvement and the fourth case of chordoma in a patient with tuberous sclerosis. This unusually rare case (surgically un-resect able) underwent endoscopic skull-base diagnostic biopsy and a novel chemotherapy regime that aimed to control his disease[i]. Initial tumour control was achieved with chemotherapy (Ifosfamide, doxorubicin with dexrazonane, intrathecal hydrocortisone, methotrexate, cytarabine). Carboplatin and etoposide were later given for a further year. Following this, Sirolimus and imatinib were used for another twelve months due to primary tumour regrowth and three new skull-vault lesions. Sirolimus alone was continued for an additional year, but stopped due to optic neuritis. Imatinib was given until further progression two years later, leading to a change to everolimus. Surgery for the ventral foramen magnum was performed a year later. The patient received further surgery and radiotherapy for tumour recurrence. Sadly the tumour metastasised and he succumbed at age 13. Chordomas are aggressive and recur frequently. Complete primary resection followed by radiotherapy/proton beam therapy offers the best chance of cure but is not an option in infants with giant lesions, as in our case. We inform on alternative targeted treatment strategies and review the literature on these rare lesions. [i] Kambogiorgas D, St George EJ, Chapman S, English M, Solanki G: Infantile Clivus chordoma without clivus involvement: Case report and review of the literature, Childs Nerv System (2006) 22:1369–1374
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Affiliation(s)
- John Apps
- Birmingham Women’s and Children’s Hospital, Birmingham, United Kingdom
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Eloise Neumann
- Birmingham Women’s and Children’s Hospital, Birmingham, United Kingdom
| | - Fardad Afshari
- Birmingham Women’s and Children’s Hospital, Birmingham, United Kingdom
| | - Guirish Solanki
- Birmingham Women’s and Children’s Hospital, Birmingham, United Kingdom
| | - Martin English
- Birmingham Women’s and Children’s Hospital, Birmingham, United Kingdom
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18
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Siebel C, Würthwein G, Lanvers-Kaminsky C, André N, Berthold F, Castelli I, Chastagner P, Doz F, English M, Escherich G, Frühwald MC, Graf N, Groll AH, Ruggiero A, Hempel G, Boos J. Can we optimise doxorubicin treatment regimens for children with cancer? Pharmacokinetic simulations and a Delphi consensus procedure. BMC Pharmacol Toxicol 2020; 21:37. [PMID: 32466789 PMCID: PMC7254632 DOI: 10.1186/s40360-020-00417-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/29/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite its cardiotoxicity doxorubicin is widely used for the treatment of paediatric malignancies. Current treatment regimens appear to be suboptimal as treatment strategies vary and do not follow a clear pharmacological rationale. Standardisation of dosing strategies in particular for infants and younger children is required but is hampered by scarcely defined exposure-response relationships. The aim is to provide a rational dosing concept allowing for a reduction of variability in systemic therapy intensity and subsequently unforeseen side effects. METHODS Doxorubicin plasma concentrations in paediatric cancer patients were simulated for different treatment schedules using a population pharmacokinetic model which considers age-dependent differences in doxorubicin clearance. Overall drug exposure and peak concentrations were assessed. Simulation results were used to support a three round Delphi consensus procedure with the aim to clarify the pharmacological goals of doxorubicin dosing in young children. A group of 28 experts representing paediatric trial groups and clinical centres were invited to participate in this process. RESULTS Pharmacokinetic simulations illustrated the substantial differences in therapy intensity associated with current dosing strategies. Consensus among the panel members was obtained on a standardised a priori dose adaptation that individualises doxorubicin doses based on age and body surface area targeting uniform drug exposure across children treated with the same protocol. Further, a reduction of peak concentrations in very young children by prolonged infusion was recommended. CONCLUSIONS An approach to standardise current dose modification schemes in young children is proposed. The consented concept takes individual pharmacokinetic characteristics into account and involves adaptation of both the dose and the infusion duration potentially improving the safety of doxorubicin administration.
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Affiliation(s)
- Christian Siebel
- Department of Paediatric Haematology and Oncology, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Muenster, Germany
| | - Gudrun Würthwein
- Department of Paediatric Haematology and Oncology, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Muenster, Germany
| | - Claudia Lanvers-Kaminsky
- Department of Paediatric Haematology and Oncology, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Muenster, Germany
| | - Nicolas André
- Department of Paediatric Haematology-Oncology, La Timone University Hospital of Marseille, Marseille, France
| | - Frank Berthold
- Department of Paediatric Oncology and Haematology, University Children's Hospital Cologne, Cologne, Germany
| | - Ilaria Castelli
- Department of Paediatrics, University of Milano-Bicocca, Hospital S Gerardo, Monza, Italy
| | - Pascal Chastagner
- Department of Paediatric Oncology, CHRU Nancy, Vandoeuvre Les Nancy, France
| | - François Doz
- Oncology Center SIREDO, Institut Curie and University Paris Descartes, Paris, France
| | - Martin English
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Gabriele Escherich
- University Medical Centre Eppendorf, Clinic of Paediatric Haematology and Oncology, Hamburg, Germany
| | - Michael C Frühwald
- Swabian Children's Cancer Centre, University Children's Hospital Augsburg, Augsburg, Germany
| | - Norbert Graf
- Department of Paediatric Haematology/Oncology, Saarland University, Homburg/Saar, Germany
| | - Andreas H Groll
- Department of Paediatric Haematology and Oncology, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Muenster, Germany
| | - Antonio Ruggiero
- Division of Paediatric Oncology, Catholic University of Rome, Rome, Italy
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry - Clinical Pharmacy, University of Muenster, Muenster, Germany
| | - Joachim Boos
- Department of Paediatric Haematology and Oncology, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Muenster, Germany.
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19
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Tyldesley-Marshall N, Greenfield S, Neilson S, English M, Adamski J, Peet A. Qualitative study: patients' and parents' views on brain tumour MRIs. Arch Dis Child 2020; 105:166-172. [PMID: 31391153 DOI: 10.1136/archdischild-2019-317306] [Citation(s) in RCA: 2] [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: 03/29/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND MRI is essential to the clinical management of children and young people with brain tumours. Advances in technology have made images more complicated to interpret, yet more easily available digitally. It is common practice to show these to patients and families, but how they emotionally respond to, understand and value, seeing brain tumour MRIs has not been formally studied. METHODS Qualitative semi-structured interviews were undertaken with 14 families (8 patients, 15 parents) purposively sampled from paediatric patients (0 to 18 years) attending a large UK children's hospital for treatment or monitoring of a brain tumour. Transcripts were analysed thematically using the Framework Method. RESULTS Four themes were identified: Receiving results (waiting for results, getting results back, preferences to see images), Emotional responses to MRIs, Understanding of images (what they can show, what they cannot show, confusion) and Value of MRIs (aesthetics, aiding understanding, contextualised knowledge/emotional benefits, enhanced control, enhanced working relationships, no value). All families found value in seeing MRIs, including reassurance, hope, improved understanding and enhanced feeling of control over the condition. However emotional responses varied enormously. CONCLUSIONS Clinical teams should always explain MRIs after 'framing' the information. This should minimise participant confusion around meaning, periodically evident even after many years. Patient and parent preferences for being shown MRIs varied, and often changed over time, therefore clinicians should identify, record and update these preferences. Time between scanning and receiving the result was stressful causing 'scanxiety', but most prioritised accuracy over speed of receiving results.
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Affiliation(s)
- Natalie Tyldesley-Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan Neilson
- Institute of Clinical Sciences, University of Birmingham, UK
| | - Martin English
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, UK
| | - Jenny Adamski
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, UK
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20
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Stevens SP, Main C, Bailey S, Pizer B, English M, Phillips B, Peet A, Avula S, Wilne S, Wheatley K, Kearns PR, Wilson JS. The utility of routine surveillance screening with magnetic resonance imaging to detect tumor recurrence/progression in children with high-grade central nervous system tumors: a systematic review. Pediatr Blood Cancer 2019; 66:e27509. [PMID: 30408313 DOI: 10.1002/pbc.27509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/14/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Surveillance magnetic resonance imaging (MRI) is routinely used to detect recurrence in children with high-grade central nervous system (CNS) tumors, although no consensus has been reached regarding its effectiveness and whether earlier detection is associated with improved patient outcomes. This review aimed to evaluate this practice and any associated benefits and harms. METHODS Systematic searches for relevant studies were undertaken in a number of databases, including MEDLINE and EMBASE, from 1985 to August 2018. Study selection and data extraction was undertaken independently by two reviewers. Due to heterogeneity between studies, no pooling of data was undertaken. Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS No comparative studies were identified. Three retrospective observational studies involving 306 patients were reviewed. All had high risk of bias by virtue of study design. Two studies reported outcomes by symptomatic status-both recurrence rates and overall survival for asymptomatic patients were comparable with those for clinically symptomatic patients. No quality-of-life outcomes were reported. CONCLUSION There is a paucity of evidence to guide clinical practice as to the effectiveness of MRI surveillance in pediatric patients with high-grade CNS tumors. These studies do not clearly demonstrate benefit or harm for the practice. With more research needed, there is a role for researchers to build into future trials data collection on surveillance imaging to give more information for the assessment of imaging frequency and duration in asymptomatic patients. This is an important question not only to clinicians and patients and their families but also from a health service resource perspective.
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Affiliation(s)
- Simon P Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Martin English
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Shivaram Avula
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sophie Wilne
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Hakimi Z, Ferchichi S, Aballea S, Odeyemi I, Toumi M, English M, Yakoub-Agha I. Burden of cytomegalovirus disease in allogeneic hematopoietic cell transplant recipients: a national, matched cohort study in an inpatient setting. Curr Res Transl Med 2018; 66:95-101. [PMID: 30274738 DOI: 10.1016/j.retram.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/28/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE OF THE STUDY No studies have compared the risk of mortality or graft-versus-host disease, in an inpatient setting in France, in allogeneic hematopoietic cell transplant recipients who develop cytomegalovirus disease with those who do not. This study assessed the impact of cytomegalovirus disease on clinical outcomes and healthcare resource utilization in allogeneic hematopoietic cell transplant recipients using the French Programme de Médicalisation des Systèmes d'Information database. PATIENTS AND METHODS Recipients who had undergone allogeneic hematopoietic cell transplant in French hospitals between 2008 and 2011 were included in this retrospective, matched cohort study. Those with cytomegalovirus disease were each matched with two allogeneic hematopoietic cell transplant recipients without cytomegalovirus disease according to demographic and clinical characteristics. Probabilities of in-hospital mortality, graft rejection and/or graft-versus-host disease, and healthcare resource utilization were compared up to 12 months after cytomegalovirus disease diagnosis. RESULTS Overall, 4884 transplant recipients were enrolled, of which 194 had cytomegalovirus disease. Of these, 165 recipients with cytomegalovirus disease were matched to 330 without cytomegalovirus disease (1:2 ratio). The development of cytomegalovirus disease was associated with a significantly higher risk of in-hospital mortality (relative risk = 1.7, p = 0.0005) and higher cumulative number of inpatient days (p < 0.0001), but was not associated with a significantly higher risk of graft rejection and/or graft-versus-host disease or healthcare costs. CONCLUSIONS Due to the increased risk of in-hospital mortality and higher cumulative number of inpatient days in allogeneic hematopoietic cell transplant recipients with cytomegalovirus disease versus those without, new strategies to prevent and manage cytomegalovirus disease are warranted.
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Affiliation(s)
- Z Hakimi
- Astellas Pharma Europe B.V., Sylviusweg 62, PO Box 344, Leiden, 2300 AH, The Netherlands
| | - S Ferchichi
- Health Economics & Outcomes Research, Creativ-Ceutical, 215 rue du Faubourg Saint-Honoré, Paris, 750086, France
| | - S Aballea
- Health Economics & Outcomes Research, Creativ-Ceutical, 215 rue du Faubourg Saint-Honoré, Paris, 750086, France
| | - I Odeyemi
- Astellas Pharma Europe Ltd., 2000 Hillswood Drive, Chertsey, KT16 0RS, UK
| | - M Toumi
- University Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, Lyon, 69622, France
| | - M English
- Astellas Pharma Global Development, Inc., Northbrook, 60062, IL, USA.
| | - I Yakoub-Agha
- CHU de Lille, LIRIC, INSERM U995, Université de Lille, 59000, France
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Stevens SP, Main C, Bailey S, Pizer B, English M, Phillips R, Peet A, Avula S, Wilne S, Wheatley K, Kearns PR, Wilson JS. The utility of routine surveillance screening with magnetic resonance imaging (MRI) to detect tumour recurrence in children with low-grade central nervous system (CNS) tumours: a systematic review. J Neurooncol 2018; 139:507-522. [PMID: 29948767 PMCID: PMC6132973 DOI: 10.1007/s11060-018-2901-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/16/2018] [Accepted: 05/12/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is routinely used as a surveillance tool to detect early asymptomatic tumour recurrence with a view to improving patient outcomes. This systematic review aimed to assess its utility in children with low-grade CNS tumours. METHODS Using standard systematic review methods, twelve databases were searched up to January 2017. RESULTS Seven retrospective case series studies (n = 370 patients) were included, with average follow-up ranging from 5.6 to 7 years. No randomised controlled trials (RCTs) were identified. Due to study heterogeneity only a descriptive synthesis could be undertaken. Imaging was most frequent in the first year post-surgery (with 2-4 scans) reducing to around half this frequency in year two and annually thereafter for the duration of follow-up. Diagnostic yield ranged from 0.25 to 2%. Recurrence rates ranged from 5 to 41%, with most recurrences asymptomatic (range 65-100%). Collectively, 56% of recurrences had occurred within the first year post-treatment (46% in the first 6-months), 68% by year two and 90% by year five. Following recurrence, 90% of patients underwent treatment changes, mainly repeat surgery (72%). Five-year OS ranged from 96 to 100%, while five-year recurrence-free survival ranged from 67 to 100%. None of the studies reported quality of life measures. CONCLUSION This systematic review highlights the paucity of evidence currently available to assess the utility of MRI surveillance despite it being routine clinical practice and costly to patients, their families and healthcare systems. This needs to be evaluated within the context of an RCT.
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Affiliation(s)
- Simon P Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Martin English
- Birmingham Women and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Shivaram Avula
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sophie Wilne
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
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Ghosh N, Manias K, Bennett CD, Oates A, English M, Peet A, Adamski J. LGG-29. RESIDUAL TUMOUR SIZE AS A PREDICTOR OF PROGRESSION FOR PAEDIATRIC LOW-GRADE GLIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.370] [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)
| | | | | | - Adam Oates
- Birmingham Children’s Hospital, Birmingham, UK
| | | | - Andrew Peet
- Birmingham Children’s Hospital, Birmingham, UK
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Bennett C, Kohe S, Gill S, Ghosh N, Manias K, Oates A, English M, Adamski J, Tennant D, Peet A. LGG-40. EX VIVO TISSUE METABOLITE PROFILES PREDICT PROGRESSION-FREE SURVIVAL IN PAEDIATRIC CEREBELLAR PILOCYTIC ASTROCYTOMAS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.381] [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)
- Christopher Bennett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Sarah Kohe
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Simrandip Gill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Neelakshi Ghosh
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Karen Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Adam Oates
- Birmingham Children’s Hospital, Birmingham, UK
| | | | | | - Daniel Tennant
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
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25
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Manias K, Gill SK, Zarinabad N, Davies P, English M, Ford D, MacPherson L, Nicklaus-Wollenteit I, Oates A, Solanki G, Adamski J, Wilson M, Peet AC. Evaluation of the added value of 1H-magnetic resonance spectroscopy for the diagnosis of pediatric brain lesions in clinical practice. Neurooncol Pract 2017; 5:18-27. [PMID: 29692921 PMCID: PMC5909808 DOI: 10.1093/nop/npx005] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Magnetic resonance spectroscopy (MRS) aids noninvasive diagnosis of pediatric brain tumors, but use in clinical practice is not well documented. We aimed to review clinical use of MRS, establish added value in noninvasive diagnosis, and investigate potential impact on patient care. Methods Sixty-nine children with lesions imaged using MRS and reviewed by the tumor board from 2014 to 2016 met inclusion criteria. Contemporaneous MRI diagnosis, spectroscopy analysis, histopathology, and clinical information were reviewed. Final diagnosis was agreed on by the tumor board at study end. Results Five cases were excluded for lack of documented MRI diagnosis. The principal MRI diagnosis by pediatric radiologists was correct in 59%, increasing to 73% with addition of MRS. Of the 73%, 19.1% (95% CI, 9.1%-33.3%) were incorrectly diagnosed with MRI alone. MRS led to a significant improvement in correct diagnosis over all tumor types (P = .012). Of diagnoses correctly made with MRI, confidence increased by 37% when adding MRS, with no patients incorrectly re-diagnosed. Indolent lesions were diagnosed noninvasively in 85% of cases, with MRS a major contributor to 91% of these diagnoses. Of all patients, 39% were managed without histopathological diagnosis. MRS contributed to diagnosis in 68% of this group, modifying it in 12%. MRS influenced management in 33% of cases, mainly through avoiding and guiding biopsy and aiding tumor characterization. Conclusion MRS can improve accuracy and confidence in noninvasive diagnosis of pediatric brain lesions in clinical practice. There is potential to improve outcomes through avoiding biopsy of indolent lesions, aiding tumor characterization, and facilitating earlier family discussions and treatment planning.
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Affiliation(s)
- Karen Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Pediatric Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Simrandip K Gill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Pediatric Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Niloufar Zarinabad
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Paul Davies
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Martin English
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Pediatric Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Daniel Ford
- Department of Clinical Oncology, Queen Elizabeth Hospital, Birmingham, UK
| | - Lesley MacPherson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Ina Nicklaus-Wollenteit
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Histopathology, Birmingham Children's Hospital, Birmingham, UK
| | - Adam Oates
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Guirish Solanki
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, UK
| | - Jenny Adamski
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Pediatric Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Martin Wilson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,School of Psychology, University of Birmingham, Birmingham, UK
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Pediatric Oncology, Birmingham Children's Hospital, Birmingham, UK
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Main C, Stevens SP, Bailey S, Phillips R, Pizer B, Wheatley K, Kearns PR, English M, Wilne S, Wilson JS. The impact of routine surveillance screening with magnetic resonance imaging (MRI) to detect tumour recurrence in children with central nervous system (CNS) tumours: protocol for a systematic review and meta-analysis. Syst Rev 2016; 5:143. [PMID: 27577246 PMCID: PMC5006428 DOI: 10.1186/s13643-016-0318-1] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to assess the impact of routine MRI surveillance to detect tumour recurrence in children with no new neurological signs or symptoms compared with alternative follow-up practices, including periodic clinical and physical examinations and the use of non-routine imaging upon presentation with disease signs or symptoms. METHODS Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Ten electronic databases have been searched, and further citation searching and reference checking will be employed. Randomised and non-randomised controlled trials assessing the impact of routine surveillance MRI to detect tumour recurrence in children with no new neurological signs or symptoms compared to alternative follow-up schedules including imaging upon presentation with disease signs or symptoms will be included. The primary outcome is time to change in therapeutic intervention. Secondary outcomes include overall survival, surrogate survival outcomes, response rates, diagnostic yield per set of images, adverse events, quality of survival and validated measures of family psychological functioning and anxiety. Two reviewers will independently screen and select studies for inclusion. Quality assessment will be undertaken using the Cochrane Collaboration's tools for assessing risk of bias. Where possible, data will be summarised using combined estimates of effect for time to treatment change, survival outcomes and response rates using assumption-free methods. Further sub-group analyses and meta-regression models will be specified and undertaken to explore potential sources of heterogeneity between studies within each tumour type if necessary. DISCUSSION Assessment of the impact of surveillance imaging in children with CNS tumours is methodologically complex. The evidence base is likely to be heterogeneous in terms of imaging protocols, definitions of radiological response and diagnostic accuracy of tumour recurrence due to changes in imaging technology over time. Furthermore, the delineation of tumour recurrence from either pseudo-progression or radiation necrosis after radiotherapy is potentially problematic and linked to the timing of follow-up assessments. However, given the current routine practice of MRI surveillance in the follow-up of children with CNS tumours in the UK and the resource implications, it is important to evaluate the cost-benefit profile of this practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016036802.
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Affiliation(s)
- Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon P. Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Barry Pizer
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R. Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Martin English
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Sophie Wilne
- Queen’s Medical Centre, Nottingham University Hospitals’ NHS Trust, Nottingham, UK
| | - Jayne S. Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Main C, Dandapani M, Pritchard M, Dodds R, Stevens SP, Thorp N, Taylor RE, Wheatley K, Pizer B, Morrall M, Phillips R, English M, Kearns PR, Wilne S, Wilson JS. The effectiveness and safety of proton beam radiation therapy in children with malignant central nervous system (CNS) tumours: protocol for a systematic review. Syst Rev 2016; 5:124. [PMID: 27460473 PMCID: PMC4962509 DOI: 10.1186/s13643-016-0285-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study is to use a systematic review framework to identify and synthesise the evidence on the use of proton beam therapy (PBT) for the treatment of children with CNS tumours and where possible compare this to the use of photon radiotherapy (RT). METHODS Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Twelve electronic databases have been searched, and further citation, hand searching and reference checking will be employed. Studies assessing the effects of PBT used either alone or as part of a multimodality treatment regimen in children with CNS tumours will be included. Relevant economic evaluations will also be identified. The outcomes are survival (overall, progression-free, event-free, disease-free), local and regional control rates, short- and long-term adverse events, functional status measures and quality of survival. Two reviewers will independently screen and select studies for inclusion in the review. All interventional study designs will be eligible for inclusion in the review. However, initial scoping searches indicate the evidence base is likely to be limited to case series studies, with no studies of a higher quality being identified. Quality assessment will be undertaken using pre-specified criteria and tailored to study design if applicable. Studies will be combined using a narrative synthesis, with differences in results between studies highlighted and discussed in relation to the patient population, intervention and study quality. Where appropriate, if no studies of a comparative design are identified, outcomes will be compared against a range of estimates from the literature for similar populations and treatment regimens from the best available evidence from studies that include the use of advanced conventional photon therapy. DISCUSSION The evidence base for the use of PBT in children with CNS tumours is likely to be relatively sparse, highly heterogeneous and potentially of a low quality with small sample sizes. Furthermore, selection and publication biases may limit the internal and external validity of studies. However, any tentative results from the review on potential treatment effects can be used to plan better quality research studies that are of a design appropriate for outcome comparison with conventional therapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015029583.
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Affiliation(s)
- Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | | | | | | | - Simon P. Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | - Nicky Thorp
- The Clatterbridge Cancer Centre, Liverpool, UK
| | | | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | - Barry Pizer
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Robert Phillips
- Leeds General Infirmary, Leeds, UK
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Martin English
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Pamela R. Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Sophie Wilne
- Queen’s Medical Centre, Nottingham University Hospitals’ NHS Trust, Nottingham, UK
| | - Jayne S. Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
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Affiliation(s)
| | | | - Andrew Peet
- University of Birmingham, Edgbaston, Birmingham, UK
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Main C, Pizer B, Wheatley K, Cooper K, Adams M, Stevens S, English M, Phillips B, Wilne S, Kearns PR, Wilson JS. MB-55THE ROLE OF HIGH-DOSE MYELOABLATIVE CHEMOTHERAPY (HDCT) WITH AUTOLOGOUS HAEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) IN CHILDREN WITH MEDULLOBLASTOMA: RESULTS OF A SYSTEMATIC REVIEW. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now076.53] [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: 11/12/2022] Open
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Woodman H, Ford D, Sangha G, Bode C, Webster G, Cashmore J, English M, Peet A, Benghiat H. RO-16EXPERIENCE OF CRANIOSPINAL TOMOTHERAPY ®IN CHILDREN AND YOUNG ADULTS: DELIVERABILITY AND ACUTE TOXICITY. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now082.16] [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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Main C, Adams M, Cooper K, Wilne S, Phillips B, English M, Kearns PR, Pizer B, Stevens SP, Wheatley K, Wilson JS. HG-54THE ROLE OF HIGH-DOSE MYELOABLATIVE CHEMOTHERAPY (HDCT) WITH HAEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) IN CHILDREN WITH HIGH GRADE GLIOMAS (HGG) OR DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG): RESULTS OF A SYSTEMATIC REVIEW. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now073.50] [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: 11/12/2022] Open
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Main C, Cooper K, Adams M, Pizer B, English M, Kearns PR, Phillips R, Stevens SP, Wilne S, Wheatley K, Wilson JS. AT-12THE ROLE OF HIGH-DOSE MYELOABLATIVE CHEMOTHERAPY (HDCT) WITH HAEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) IN CHILDREN WITH ATYPICAL TERATOID RHABDOID TUMOURS (AT/RT): RESULTS OF A SYSTEMATIC REVIEW. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now065.11] [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: 11/14/2022] Open
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Vivekanandan S, Breene R, Ramanujachar R, Traunecker H, Pizer B, Gaze MN, Saran F, Thorp N, English M, Wheeler K, Michalski A, Walker DA, Saunders D, Cowie F, Cameron A, Picton S, Parashar D, Horan G, Williams MV. Reply to Comment on: The UK Experience of a Treatment Strategy for Pediatric Metastatic Medulloblastoma Comprising Intensive Induction Chemotherapy, Hyperfractionated Accelerated Radiotherapy, and Response-Directed High-Dose Myeloablative Chemotherapy or Maintenance Chemotherapy (Milan Strategy). Pediatr Blood Cancer 2016; 63:1125-6. [PMID: 26891280 DOI: 10.1002/pbc.25946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | - R Breene
- Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK
| | - R Ramanujachar
- Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H Traunecker
- Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
| | - B Pizer
- Paediatric Oncology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - M N Gaze
- Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - F Saran
- Clinical Oncology, The Royal Marsden NHS Foundation Trust, Surrey, UK
| | - N Thorp
- Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - M English
- Paediatric Oncology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - K Wheeler
- Paediatric Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Michalski
- Paediatric Oncology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - D A Walker
- Paediatric Oncology, Nottingham Children's Hospital University of Nottingham, Nottingham, UK
| | - D Saunders
- Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - F Cowie
- Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Cameron
- Clinical Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - S Picton
- Paediatric Oncology, The Leeds Teaching Hospitals, Leeds, UK
| | - D Parashar
- Cancer Research Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - G Horan
- Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK
| | - M V Williams
- Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK
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Storer LC, Ritzmann T, Chapman RJ, Hanson M, Jaspan T, Dineen R, Avula S, Stivaros S, MacArthur D, Mallucci C, Chakraborty A, Aquilina K, Kamaly-Asl I, Goodden J, Thorp N, Whitfield G, Paine S, Sehested AM, Kilday JP, English M, Grundy RG. EPN-16THE SIOP II EPENDYMOMA MULTI-DISCIPLINARY ADVISORY GROUP (EMAG): THE UK APPROACH. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now070.15] [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: 11/14/2022] Open
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Main C, Stevens SP, Thorp N, Taylor RE, Dandapani M, Pritchard MG, Dodds R, Wheatley K, Kearns PR, Pizer B, Phillips B, Morrall MC, English M, Wilne S, Wilson JS. RO-08THE EFFECTIVENESS AND SAFETY OF PBT IN CHILDREN WITH MALIGNANT CENTRAL NERVOUS SYSTEM (CNS) TUMOURS: A SYSTEMATIC REVIEW. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now082.08] [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: 11/12/2022] Open
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Manias K, English M, Ford D, Gill S, MacPherson L, Nicklaus-Wollenteit I, Rodrigues D, Peet A. RA-11ADDED VALUE OF 1-H MAGNETIC RESONANCE SPECTROSCOPY FOR THE DIAGNOSIS OF PAEDIATRIC BRAIN LESIONS IN CLINICAL PRACTICE. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now083.10] [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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Main C, Wilson J, English M, Kearns P, Phillips B, Pizer B, Wilne S, Wheatley K. Does ‘mapping’ the evidence usefully inform the research question prioritisation process in systematic reviews? Trials 2015. [PMCID: PMC4660331 DOI: 10.1186/1745-6215-16-s2-p170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Vivekanandan S, Breene R, Ramanujachar R, Traunecker H, Pizer B, Gaze MN, Saran F, Thorp N, English M, Wheeler KA, Michalski A, Walker DA, Saunders D, Cowie F, Cameron A, Picton SV, Parashar D, Horan G, Williams MV. The UK Experience of a Treatment Strategy for Pediatric Metastatic Medulloblastoma Comprising Intensive Induction Chemotherapy, Hyperfractionated Accelerated Radiotherapy and Response Directed High Dose Myeloablative Chemotherapy or Maintenance Chemotherapy (Milan Strategy). Pediatr Blood Cancer 2015; 62:2132-9. [PMID: 26274622 DOI: 10.1002/pbc.25663] [Citation(s) in RCA: 18] [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: 11/28/2014] [Accepted: 06/19/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Historically, the 5-year overall survival (OS) for metastatic medulloblastoma (MMB) was less than 40%. The strategy of post-operative induction chemotherapy (IC) followed by hyperfractionated accelerated radiotherapy (HART) and response directed high dose chemotherapy (HDC) was reported in a single center study to improve 5-year OS to 73%. We report outcomes of this strategy in UK. METHODS Questionnaires were sent to all 20 UK pediatric oncology primary treatment centers to collect retrospective data on delivered treatment, toxicity and survival with this strategy in children aged 3-19 years with MMB. RESULTS Between February 2009 and October 2011, 34 patients fulfilled the entry criteria of the original study. The median age was 7 years (range 3-15). Median interval from surgery to HART was 109 versus 85 days in the original series. The incidence of grade 3 or 4 hematological toxicities with IC and HDC was 83-100%. All 16 patients who achieved complete response by the end of the regimen remain in remission but only three of 18 patients with lesser responses are still alive (P < 0.0001). With a median follow-up of 45 months for survivors, the estimated 3-year OS is 56% (95% CI 38, 71). This result is outside the 95% CI of the original study results and encompasses the historical survival result of 40%. CONCLUSION Within the limits of statistical significance, we did not replicate the improved survival results reported in the original series. The reasons include differences in patient sub-groups and protocol administration. International randomized phase III studies are needed.
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Affiliation(s)
- Sindu Vivekanandan
- Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK
| | - Richard Breene
- Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK
| | - Ramya Ramanujachar
- Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Barry Pizer
- Paediatric Oncology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Mark N Gaze
- Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Frank Saran
- Clinical Oncology, The Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Nicky Thorp
- Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - Martin English
- Paediatric Oncology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Kate Ah Wheeler
- Paediatric Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Antony Michalski
- Paediatric Oncology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - David A Walker
- Paediatric Oncology, Nottingham Children's Hospital University of Nottingham, Nottingham, UK
| | - Daniel Saunders
- Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Fiona Cowie
- Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Alison Cameron
- Clinical Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Susan V Picton
- Paediatric Oncology, The Leeds Teaching Hospitals, Leeds, UK
| | - Deepak Parashar
- Cancer Research Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Gail Horan
- Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK
| | - Michael V Williams
- Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK
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Main C, Wilson JS, Stevens SP, Houlton AE, English M, Kearns PR, Phillips B, Pizer B, Wilne S, Wheatley K. The role of high-dose myeloablative chemotherapy with haematopoietic stem cell transplantation (HSCT) in children with central nervous system (CNS) tumours: protocol for a systematic review and meta-analysis. Syst Rev 2015; 4:168. [PMID: 26589619 PMCID: PMC4654793 DOI: 10.1186/s13643-015-0155-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/09/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The objective of the study is to conduct a systematic review to compare the effects of high-dose chemotherapy (HDCT) with autologous haematopoietic stem cell transplantation (HSCT) versus standard-dose chemotherapy (SDCT) in children with malignant central nervous system (CNS) tumours. METHODS Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Ten electronic databases will be searched, along with citation searching and reference checking. Studies assessing the effects of HDCT with HSCT in children with CNS tumours will be included. The outcomes are survival (overall, progression-free, event-free, disease-free), response rates, short- and long-term adverse events and health-related quality of life (HRQoL). Two reviewers will independently screen and select randomised and non-randomised controlled trials and controlled and uncontrolled observational studies for inclusion. Quality assessment will be tailored to the different study designs. Where possible data will be summarised using combined estimates of effect for the hazard ratio for survival outcomes and the risk ratio for response rates. A fixed effect model will be used; sub-group analyses and meta-regression will be used to explore potential sources of heterogeneity between studies. DISCUSSION Given the poor prognosis of malignant brain tumours in children in terms of survival and quality of life, this review will help guide clinical practice by summarising the current evidence on the use of high-dose myeloblative chemotherapy with stem cell support in children with CNS tumours.
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Affiliation(s)
- Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Simon P Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Aimee E Houlton
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Martin English
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Bob Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK.
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - Sophie Wilne
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK.
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
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Gathara D, Aluvaala J, Mwinga S, Kihuba E, Kosgei R, Nyamai R, Mogoa W, Allen E, Todd J, English M. Exploring Variability in Care Between Hospitals Using Malaria Process Indicators Using Data From a Cross-Sectional Survey of 22 Hospitals. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.034] [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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Vivekanandan S, Breene R, Ramanujachar R, Traunecker H, Pizer B, Gaze M, Saran F, Thorpe N, Picton S, English M, Wheeler K, Michalski A, Walker DA, Saunders D, Cowie F, Cameron A, Lee V, Parashar DH. P16 * METASTATIC MEDULLOBLASTOMA - UK RESULTS WITH INDUCTION AND HIGH DOSE CHEMOTHERAPY WITH HYPERFRACTIONATED ACCELERATED RADIOTHERAPY (THE MILAN STRATEGY). Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou249.15] [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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Wilson M, Gill SK, MacPherson L, English M, Arvanitis TN, Peet AC. Noninvasive detection of glutamate predicts survival in pediatric medulloblastoma. Clin Cancer Res 2014; 20:4532-9. [PMID: 24947932 DOI: 10.1158/1078-0432.ccr-13-2320] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Medulloblastoma is the most common malignant brain tumor occurring in childhood and is a significant cause of morbidity and mortality in pediatric oncology. More intense treatment strategies are recommended for patients displaying high-risk factors; however, considerable variation in outcome remains, indicating a need for improved predictive markers. In this study, 1H magnetic resonance spectroscopy (MRS) was used to investigate noninvasive molecular biomarkers of survival in medulloblastoma. EXPERIMENTAL DESIGN MRS was performed on a series of 35 biopsy-confirmed medulloblastoma cases. One case was excluded because of poor quality MRS. The prognostic value of MRS detectable biomarkers was investigated using Cox regression, retrospectively (N=15). A subsequent validation analysis (N=19) was also performed to reduce the chance of type I errors. Where available, high-resolution ex vivo MRS of biopsy tissue was used to confirm biomarker assignments. RESULTS The retrospective analysis revealed that creatine, glutamate, and glycine were markers of survival (P<0.01). The validation analysis showed that glutamate was a robust marker, with a hazard ration (HR) of 8.0 for the full dataset (P=0.0003, N=34). A good correlation between in vivo and ex vivo MRS glutamate/total-choline was found (P=0.001), validating the in vivo assignment. Ex vivo glutamate/total-choline was also associated with survival (P<0.01). CONCLUSION The identification of glutamate as a predictive biomarker of survival in pediatric medulloblastoma provides a clinically viable risk factor and highlights the importance of more detailed studies into the metabolism of this disease. Noninvasive biomarker detection using MRS may offer improved disease monitoring and potential for widespread use following multicenter validation.
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Affiliation(s)
- Martin Wilson
- School of Cancer Sciences, University of Birmingham, Birmingham; Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and
| | - Simrandip K Gill
- School of Cancer Sciences, University of Birmingham, Birmingham; Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and
| | - Lesley MacPherson
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and
| | - Martin English
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and
| | - Theodoros N Arvanitis
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Andrew C Peet
- School of Cancer Sciences, University of Birmingham, Birmingham; Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and
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Shofty B, Bokstein F, Ram Z, Ben-Sira L, Freedman S, Kesler A, Constantini S, Shofty B, Mauda-Havakuk M, Ben-Bashat D, Dvir R, Pratt LT, Weizman L, Joskowicz L, Tal M, Ravid L, Ben-Sira L, Constantini S, Dodgshun A, Maixner W, Sullivan M, Hansford J, Ma J, Wang B, Toledano H, Muhsinoglu O, Luckman J, Michowiz S, Goldenberg-Cohen N, Schroeder K, Rosenfeld A, Grant G, McLendon R, Cummings T, Becher O, Gururangan S, Aguilera D, Mazewski C, Janss A, Castellino RC, Schniederjan M, Hayes L, Brahma B, MacDonald T, Osugi Y, Kiyotani C, Sakamoto H, Yanagisawa T, Kanno M, Kamimura S, Kosaka Y, Hirado J, Takimoto T, Nakazawa A, Hara J, Hwang E, Mun A, Kilburn L, Chi S, Knipstein J, Oren M, Dvir R, Hardy K, Rood B, Packer R, Kandels D, Schmidt R, Geh M, Breitmoser-Greiner S, Gnekow AK, Bergthold G, Bandopadhayay P, Rich B, Chan J, Santagata S, Hoshida Y, Ramkissoon S, Ramkissoon L, Golub T, Tabak B, Ferrer-Luna R, Weng PY, Stiles C, Grill J, Kieran MW, Ligon KL, Beroukhim R, Fisher MJ, Levin MH, Armstrong GT, Broad JH, Zimmerman R, Bilaniuk LT, Feygin T, Liu GT, Gan HW, Phipps K, Spoudeas HA, Kohorst M, Warad D, Keating G, Childs S, Giannini C, Wetjen N, Rao; AN, Nakamura H, Makino K, Hide T, Kuroda JI, Shinojima N, Yano S, Kuratsu JI, Rush S, Madden J, Hemenway M, Foreman N, Sie M, den Dunnen WFA, Lourens HJ, Meeuwsen-de Boer TGJ, Scherpen FJG, Kampen KR, Hoving EW, de Bont ESJM, Gnekow AK, Kandels D, Walker DA, Perilongo G, Grill J, Stokland T, Sehested AM, van Schouten AYN, de Paoli A, de Salvo GL, Pache-Leschhorn S, Geh M, Schmidt R, Gnekow AK, Gass D, Rupani K, Tsankova N, Stark E, Anderson R, Feldstein N, Garvin J, Deel M, McLendon R, Becher O, Karajannis M, Wisoff J, Muh C, Schroeder K, Gururangan S, del Bufalo F, Carai A, Macchiaiolo M, Messina R, Cacchione A, Palmiero M, Cambiaso P, Mastronuzzi A, Anderson M, Leary S, Sun Y, Buhrlage S, Pilarz C, Alberta J, Stiles C, Gray N, Mason G, Packer R, Hwang E, Biassoni V, Schiavello E, Bergamaschi L, Chiaravalli S, Spreafico F, Massimino M, Krishnatry R, Kroupnik T, Zhukova N, Mistry M, Zhang C, Bartels U, Huang A, Adamski J, Dirks P, Laperriere N, Silber J, Hawkins C, Bouffet E, Tabori U, Riccardi R, Rizzo D, Chiaretti A, Piccardi M, Dickmann A, Lazzareschi I, Ruggiero A, Guglielmi G, Salerni A, Manni L, Colosimo C, Falsini B, Rosenfeld A, Etzl M, Miller J, Carpenteri D, Kaplan A, Sieow N, Hoe R, Tan AM, Chan MY, Soh SY, Orphanidou-Vlachou E, MacPherson L, English M, Auer D, Jaspan T, Arvanitis T, Grundy R, Peet A, Bandopadhayay P, Bergthold G, Sauer N, Green A, Malkin H, Dabscheck G, Marcus K, Ullrich N, Goumnerova L, Chi S, Beroukhim R, Kieran M, Manley P, Donson A, Kleinschmidt-DeMasters B, Aisner D, Bemis L, Birks D, Mulcahy-Levy J, Smith A, Handler M, Rush S, Foreman N, Davidson A, Figaji A, Pillay K, Kilborn T, Padayachy L, Hendricks M, van Eyssen A, Parkes J, Gass D, Dewire M, Chow L, Rose SR, Lawson S, Stevenson C, Jones B, Pai A, Sutton M, Pruitt D, Fouladi M, Hummel T, Cruz O, de Torres C, Sunol M, Morales A, Santiago C, Alamar M, Rebollo M, Mora J, Sauer N, Dodgshun A, Malkin H, Bergthold G, Manley P, Chi S, Ramkissoon S, MacGregor D, Beroukhim R, Kieran M, Sullivan M, Ligon K, Bandopadhayay P, Hansford J, Messina R, De Benedictis A, Carai A, Mastronuzzi A, Rebessi E, Palma P, Procaccini E, Marras CE, Aguilera D, Castellino RC, Janss A, Schniederjan M, McNall R, Kim S, MacDOnald T, Mazewski C, Zhukova N, Pole J, Mistry M, Fried I, Krishnatry R, Stucklin AG, Bartels U, Huang A, Laperriere N, Dirks P, Zelcer S, Sylva M, Johnston D, Scheinemann K, An J, Hawkins C, Nathan P, Greenberg M, Bouffet E, Malkin D, Tabori U, Kiehna E, Da Silva S, Margol A, Robison N, Finlay J, McComb JG, Krieger M, Wong K, Bluml S, Dhall G, Ayyanar K, Moriarty T, Moeller K, Farber D. LOW GRADE GLIOMAS. Neuro Oncol 2014; 16:i60-i70. [PMCID: PMC4046289 DOI: 10.1093/neuonc/nou073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
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Vaidyanathan G, Gururangan S, Bigner D, Zalutsky M, Morfouace M, Shelat A, Megan J, Freeman BB, Robinson S, Throm S, Olson JM, Li XN, Guy KR, Robinson G, Stewart C, Gajjar A, Roussel M, Sirachainan N, Pakakasama S, Anurathapan U, Hansasuta A, Dhanachai M, Khongkhatithum C, Hongeng S, Feroze A, Lee KS, Gholamin S, Wu Z, Lu B, Mitra S, Cheshier S, Northcott P, Lee C, Zichner T, Lichter P, Korbel J, Wechsler-Reya R, Pfister S, Project IPT, Li KKW, Xia T, Ma FMT, Zhang R, Zhou L, Lau KM, Ng HK, Lafay-Cousin L, Chi S, Madden J, Smith A, Wells E, Owens E, Strother D, Foreman N, Packer R, Bouffet E, Wataya T, Peacock J, Taylor MD, Ivanov D, Garnett M, Parker T, Alexander C, Meijer L, Grundy R, Gellert P, Ashford M, Walker D, Brent J, Cader FZ, Ford D, Kay A, Walsh R, Solanki G, Peet A, English M, Shalaby T, Fiaschetti G, Baulande S, Gerber N, Baumgartner M, Grotzer M, Hayase T, Kawahara Y, Yagi M, Minami T, Kanai N, Yamaguchi T, Gomi A, Morimoto A, Hill R, Kuijper S, Lindsey J, Schwalbe E, Barker K, Boult J, Williamson D, Ahmad Z, Hallsworth A, Ryan S, Poon E, Robinson S, Ruddle R, Raynaud F, Howell L, Kwok C, Joshi A, Nicholson SL, Crosier S, Wharton S, Robson K, Michalski A, Hargrave D, Jacques T, Pizer B, Bailey S, Swartling F, Petrie K, Weiss W, Chesler L, Clifford S, Kitanovski L, Prelog T, Kotnik BF, Debeljak M, Fiaschetti G, Shalaby T, Baumgartner M, Grotzer MA, Gevorgian A, Morozova E, Kazantsev I, Iukhta T, Safonova S, Kumirova E, Punanov Y, Afanasyev B, Zheludkova O, Grajkowska W, Pronicki M, Cukrowska B, Dembowska-Baginska B, Lastowska M, Murase A, Nobusawa S, Gemma Y, Yamazaki F, Masuzawa A, Uno T, Osumi T, Shioda Y, Kiyotani C, Mori T, Matsumoto K, Ogiwara H, Morota N, Hirato J, Nakazawa A, Terashima K, Fay-McClymont T, Walsh K, Mabbott D, Smith A, Wells E, Madden J, Chi S, Owens E, Strother D, Packer R, Foreman N, Bouffet E, Lafay-Cousin L, Sturm D, Northcott PA, Jones DTW, Korshunov A, Lichter P, Pfister SM, Kool M, Hooper C, Hawes S, Kees U, Gottardo N, Dallas P, Siegfried A, Bertozzi AI, Sevely A, Loukh N, Munzer C, Miquel C, Bourdeaut F, Pietsch T, Dufour C, Delisle MB, Kawauchi D, Rehg J, Finkelstein D, Zindy F, Phoenix T, Gilbertson R, Pfister S, Roussel M, Trubicka J, Borucka-Mankiewicz M, Ciara E, Chrzanowska K, Perek-Polnik M, Abramczuk-Piekutowska D, Grajkowska W, Jurkiewicz D, Luczak S, Kowalski P, Krajewska-Walasek M, Lastowska M, Sheila C, Lee S, Foster C, Manoranjan B, Pambit M, Berns R, Fotovati A, Venugopal C, O'Halloran K, Narendran A, Hawkins C, Ramaswamy V, Bouffet E, Taylor M, Singhal A, Hukin J, Rassekh R, Yip S, Northcott P, Singh S, Duhman C, Dunn S, Chen T, Rush S, Fuji H, Ishida Y, Onoe T, Kanda T, Kase Y, Yamashita H, Murayama S, Nakasu Y, Kurimoto T, Kondo A, Sakaguchi S, Fujimura J, Saito M, Arakawa T, Arai H, Shimizu T, Lastowska M, Jurkiewicz E, Daszkiewicz P, Drogosiewicz M, Trubicka J, Grajkowska W, Pronicki M, Kool M, Sturm D, Jones DTW, Hovestadt V, Buchhalter I, Jager NN, Stuetz A, Johann P, Schmidt C, Ryzhova M, Landgraf P, Hasselblatt M, Schuller U, Yaspo ML, von Deimling A, Korbel J, Eils R, Lichter P, Korshunov A, Pfister S, Modi A, Patel M, Berk M, Wang LX, Plautz G, Camara-Costa H, Resch A, Lalande C, Kieffer V, Poggi G, Kennedy C, Bull K, Calaminus G, Grill J, Doz F, Rutkowski S, Massimino M, Kortmann RD, Lannering B, Dellatolas G, Chevignard M, Lindsey J, Kawauchi D, Schwalbe E, Solecki D, McKinnon P, Olson J, Hayden J, Grundy R, Ellison D, Williamson D, Bailey S, Roussel M, Clifford S, Buss M, Remke M, Lee J, Caspary T, Taylor M, Castellino R, Lannering B, Sabel M, Gustafsson G, Fleischhack G, Benesch M, Doz F, Kortmann RD, Massimino M, Navajas A, Reddingius R, Rutkowski S, Miquel C, Delisle MB, Dufour C, Lafon D, Sevenet N, Pierron G, Delattre O, Bourdeaut F, Ecker J, Oehme I, Mazitschek R, Korshunov A, Kool M, Lodrini M, Deubzer HE, von Deimling A, Kulozik AE, Pfister SM, Witt O, Milde T, Phoenix T, Patmore D, Boulos N, Wright K, Boop S, Gilbertson R, Janicki T, Burzynski S, Burzynski G, Marszalek A, Triscott J, Green M, Foster C, Fotovati A, Berns R, O'Halloran K, Singhal A, Hukin J, Rassekh SR, Yip S, Toyota B, Dunham C, Dunn SE, Liu KW, Pei Y, Wechsler-Reya R, Genovesi L, Ji P, Davis M, Ng CG, Remke M, Taylor M, Cho YJ, Jenkins N, Copeland N, Wainwright B, Tang Y, Schubert S, Nguyen B, Masoud S, Gholamin S, Lee A, Willardson M, Bandopadhayay P, Bergthold G, Atwood S, Whitson R, Cheshier S, Qi J, Beroukhim R, Tang J, Wechsler-Reya R, Oro A, Link B, Bradner J, Cho YJ, Vallero SG, Bertin D, Basso ME, Milanaccio C, Peretta P, Cama A, Mussano A, Barra S, Morana G, Morra I, Nozza P, Fagioli F, Garre ML, Darabi A, Sanden E, Visse E, Stahl N, Siesjo P, Cho YJ, Vaka D, Schubert S, Vasquez F, Weir B, Cowley G, Keller C, Hahn W, Gibbs IC, Partap S, Yeom K, Martinez M, Vogel H, Donaldson SS, Fisher P, Perreault S, Cho YJ, Guerrini-Rousseau L, Dufour C, Pujet S, Kieffer-Renaux V, Raquin MA, Varlet P, Longaud A, Sainte-Rose C, Valteau-Couanet D, Grill J, Staal J, Lau LS, Zhang H, Ingram WJ, Cho YJ, Hathout Y, Brown K, Rood BR, Sanden E, Visse E, Stahl N, Siesjo P, Darabi A, Handler M, Hankinson T, Madden J, Kleinschmidt-Demasters BK, Foreman N, Hutter S, Northcott PA, Kool M, Pfister S, Kawauchi D, Jones DT, Kagawa N, Hirayama R, Kijima N, Chiba Y, Kinoshita M, Takano K, Eino D, Fukuya S, Yamamoto F, Nakanishi K, Hashimoto N, Hashii Y, Hara J, Taylor MD, Yoshimine T, Wang J, Guo C, Yang Q, Chen Z, Perek-Polnik M, Lastowska M, Drogosiewicz M, Dembowska-Baginska B, Grajkowska W, Filipek I, Swieszkowska E, Tarasinska M, Perek D, Kebudi R, Koc B, Gorgun O, Agaoglu FY, Wolff J, Darendeliler E, Schmidt C, Kerl K, Gronych J, Kawauchi D, Lichter P, Schuller U, Pfister S, Kool M, McGlade J, Endersby R, Hii H, Johns T, Gottardo N, Sastry J, Murphy D, Ronghe M, Cunningham C, Cowie F, Jones R, Sastry J, Calisto A, Sangra M, Mathieson C, Brown J, Phuakpet K, Larouche V, Hawkins C, Bartels U, Bouffet E, Ishida T, Hasegawa D, Miyata K, Ochi S, Saito A, Kozaki A, Yanai T, Kawasaki K, Yamamoto K, Kawamura A, Nagashima T, Akasaka Y, Soejima T, Yoshida M, Kosaka Y, Rutkowski S, von Bueren A, Goschzik T, Kortmann R, von Hoff K, Friedrich C, Muehlen AZ, Gerber N, Warmuth-Metz M, Soerensen N, Deinlein F, Benesch M, Zwiener I, Faldum A, Kuehl J, Pietsch T, KRAMER K, -Taskar NP, Zanzonico P, Humm JL, Wolden SL, Cheung NKV, Venkataraman S, Alimova I, Harris P, Birks D, Balakrishnan I, Griesinger A, Remke M, Taylor MD, Handler M, Foreman NK, Vibhakar R, Margol A, Robison N, Gnanachandran J, Hung L, Kennedy R, Vali M, Dhall G, Finlay J, Erdrich-Epstein A, Krieger M, Drissi R, Fouladi M, Gilles F, Judkins A, Sposto R, Asgharzadeh S, Peyrl A, Chocholous M, Holm S, Grillner P, Blomgren K, Azizi A, Czech T, Gustafsson B, Dieckmann K, Leiss U, Slavc I, Babelyan S, Dolgopolov I, Pimenov R, Mentkevich G, Gorelishev S, Laskov M, Friedrich C, Warmuth-Metz M, von Bueren AO, Nowak J, von Hoff K, Pietsch T, Kortmann RD, Rutkowski S, Mynarek M, von Hoff K, Muller K, Friedrich C, von Bueren AO, Gerber NU, Benesch M, Pietsch T, Warmuth-Metz M, Ottensmeier H, Kwiecien R, Faldum A, Kuehl J, Kortmann RD, Rutkowski S, Mynarek M, von Hoff K, Muller K, Friedrich C, von Bueren AO, Gerber NU, Benesch M, Pietsch T, Warmuth-Metz M, Ottensmeier H, Kwiecien R, Faldum A, Kuehl J, Kortmann RD, Rutkowski S, Yankelevich M, Laskov M, Boyarshinov V, Glekov I, Pimenov R, Ozerov S, Gorelyshev S, Popa A, Dolgopolov I, Subbotina N, Mentkevich G, Martin AM, Nirschl C, Polanczyk M, Bell R, Martinez D, Sullivan LM, Santi M, Burger PC, Taube JM, Drake CG, Pardoll DM, Lim M, Li L, Wang WG, Pu JX, Sun HD, Remke M, Taylor MD, Ruggieri R, Symons MH, Vanan MI, Bandopadhayay P, Bergthold G, Nguyen B, Schubert S, Gholamin S, Tang Y, Bolin S, Schumacher S, Zeid R, Masoud S, Yu F, Vue N, Gibson W, Paolella B, Mitra S, Cheshier S, Qi J, Liu KW, Wechsler-Reya R, Weiss W, Swartling FJ, Kieran MW, Bradner JE, Beroukhim R, Cho YJ, Maher O, Khatua S, Tarek N, Zaky W, Gupta T, Mohanty S, Kannan S, Jalali R, Kapitza E, Denkhaus D, Muhlen AZ, Rutkowski S, Pietsch T, von Hoff K, Pizer B, Dufour C, van Vuurden DG, Garami M, Massimino M, Fangusaro J, Davidson TB, da Costa MJG, Sterba J, Benesch M, Gerber NU, Mynarek M, Kwiecien R, Clifford SC, Kool M, Pietsch T, Finlay JL, Rutkowski S, Pietsch T, Schmidt R, Remke M, Korshunov A, Hovestadt V, Jones DT, Felsberg J, Goschzik T, Kool M, Northcott PA, von Hoff K, von Bueren A, Skladny H, Taylor M, Cremer F, Lichter P, Faldum A, Reifenberger G, Rutkowski S, Pfister S, Kunder R, Jalali R, Sridhar E, Moiyadi AA, Goel A, Goel N, Shirsat N, Othman R, Storer L, Korshunov A, Pfister SM, Kerr I, Coyle B, Law N, Smith ML, Greenberg M, Bouffet E, Taylor MD, Laughlin S, Malkin D, Liu F, Moxon-Emre I, Scantlebury N, Mabbott D, Nasir A, Othman R, Storer L, Onion D, Lourdusamy A, Grabowska A, Coyle B, Cai Y, Othman R, Bradshaw T, Coyle B, de Medeiros RSS, Beaugrand A, Soares S, Epelman S, Jones DTW, Hovestadt V, Wang W, Northcott PA, Kool M, Sultan M, Landgraf P, Reifenberger G, Eils R, Yaspo ML, Wechsler-Reya RJ, Korshunov A, Zapatka M, Radlwimmer B, Pfister SM, Lichter P, Alderete D, Baroni L, Lubinieki F, Auad F, Gonzalez ML, Puya W, Pacheco P, Aurtenetxe O, Gaffar A, Gros L, Cruz O, Calvo C, Navajas A, Shinojima N, Nakamura H, Kuratsu JI, Hanaford A, Eberhart C, Archer T, Tamayo P, Pomeroy S, Raabe E, De Braganca K, Gilheeney S, Khakoo Y, Kramer K, Wolden S, Dunkel I, Lulla RR, Laskowski J, Fangusaro J, Goldman S, Gopalakrishnan V, Ramaswamy V, Remke M, Shih D, Wang X, Northcott P, Faria C, Raybaud C, Tabori U, Hawkins C, Rutka J, Taylor M, Bouffet E, Jacobs S, De Vathaire F, Diallo I, Llanas D, Verez C, Diop F, Kahlouche A, Grill J, Puget S, Valteau-Couanet D, Dufour C, Ramaswamy V, Thompson E, Taylor M, Pomeroy S, Archer T, Northcott P, Tamayo P, Prince E, Amani V, Griesinger A, Foreman N, Vibhakar R, Sin-Chan P, Lu M, Kleinman C, Spence T, Picard D, Ho KC, Chan J, Hawkins C, Majewski J, Jabado N, Dirks P, Huang A, Madden JR, Foreman NK, Donson AM, Mirsky DM, Wang X, Dubuc A, Korshunov A, Ramaswamy V, Remke M, Mack S, Gendoo D, Peacock J, Luu B, Cho YJ, Eberhart C, MacDonald T, Li XN, Van Meter T, Northcott P, Croul S, Bouffet E, Pfister S, Taylor M, Laureano A, Brugmann W, Denman C, Singh H, Huls H, Moyes J, Khatua S, Sandberg D, Silla L, Cooper L, Lee D, Gopalakrishnan V. MEDULLOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou074] [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: 11/14/2022] Open
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Gill SK, Wilson M, Davies NP, MacPherson L, English M, Arvanitis TN, Peet AC. Diagnosing relapse in children's brain tumors using metabolite profiles. Neuro Oncol 2013; 16:156-64. [PMID: 24305716 DOI: 10.1093/neuonc/not143] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Malignant brain tumors in children generally have a very poor prognosis when they relapse and improvements are required in their management. It can be difficult to accurately diagnose abnormalities detected during tumor surveillance, and new techniques are required to aid this process. This study investigates how metabolite profiles measured noninvasively by (1)H magnetic resonance spectroscopy (MRS) at relapse reflect those at diagnosis and may be used in this monitoring process. METHODS Single-voxel MRS (1.5 T, point-resolved spectroscopy, echo time 30 ms, repetition time 1500 ms was performed on 19 children with grades II-IV brain tumors during routine MRI scans prior to treatment for a suspected brain tumor and at suspected first relapse. MRS was analyzed using TARQUIN software to provide metabolite concentrations. Paired Student's t-tests were performed between metabolite profiles at diagnosis and at first relapse. RESULTS There was no significant difference (P > .05) in the level of any metabolite, lipid, or macromolecule from tumors prior to treatment and at first relapse. This was true for the whole group (n = 19), those with a local relapse (n = 12), and those with a distant relapse (n = 7). Lipids at 1.3 ppm were close to significance when comparing the level at diagnosis with that at distant first relapse (P = .07, 6.5 vs 12.9). In 5 cases the MRS indicative of tumor preceded a formal diagnosis of relapse. CONCLUSIONS Tumor metabolite profiles, measured by MRS, do not change greatly from diagnosis to first relapse, and this can aid the confirmation of the presence of tumor.
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Affiliation(s)
- Simrandip K Gill
- Corresponding author: Andrew C. Peet, MRCPCH, PhD, Institute of Child Health, Clinical Research Block, Whittall Street, Birmingham B4 6NH, UK.
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Rogers S, Donachie P, Sugden E, Sharpe G, English M, Robinson K, Saran F. Comparison of permanent hair loss in children with standard risk PNETS of the posterior fossa following radiotherapy alone or chemotherapy and radiotherapy after surgical resection. Pediatr Blood Cancer 2011; 57:1074-6. [PMID: 21744477 DOI: 10.1002/pbc.22992] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 12/01/2010] [Indexed: 11/08/2022]
Abstract
Hair loss was compared between surgery followed by craniospinal radiotherapy (CSRT) or chemotherapy then CSRT (C-CSRT) for medulloblastoma. The proportion of patients exhibiting hair loss in the cranial field was 70.0% (C-CSRT) versus 30.0% (CSRT) (95% CI: 14.7% to 58.9%; P = 0.002). The C-CSRT group also experienced more virtual/complete hair loss over the posterior fossa boost. Age was a significant contributor to hair loss in the cranial field. Persistent significant hair loss is an under-reported late effect of treatment that could influence quality of survival and should be considered in future trial design.
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Woodruff C, English M, Zaouter C, Hemmerling TM. Postoperative visual loss after plastic surgery: case report and a novel continuous real-time video monitoring system for the eyes during prone surgery. Br J Anaesth 2011; 106:149-51. [PMID: 21148645 DOI: 10.1093/bja/aeq349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Duke T, Graham SM, Cherian MN, Ginsburg AS, English M, Howie S, Peel D, Enarson PM, Wilson IH, Were W. Oxygen is an essential medicine: a call for international action. Int J Tuberc Lung Dis 2010; 14:1362-1368. [PMID: 20937173 PMCID: PMC2975100] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Hypoxaemia is commonly associated with mortality in developing countries, yet feasible and cost-effective ways to address hypoxaemia receive little or no attention in current global health strategies. Oxygen treatment has been used in medicine for almost 100 years, but in developing countries most seriously ill newborns, children and adults do not have access to oxygen or the simple test that can detect hypoxaemia. Improving access to oxygen and pulse oximetry has demonstrated a reduction in mortality from childhood pneumonia by up to 35% in high-burden child pneumonia settings. The cost-effectiveness of an oxygen systems strategy compares favourably with other higher profile child survival interventions, such as new vaccines. In addition to its use in treating acute respiratory illness, oxygen treatment is required for the optimal management of many other conditions in adults and children, and is essential for safe surgery, anaesthesia and obstetric care. Oxygen concentrators provide the most consistent and least expensive source of oxygen in health facilities where power supplies are reliable. Oxygen concentrators are sustainable in developing country settings if a systematic approach involving nurses, doctors, technicians and administrators is adopted. Improving oxygen systems is an entry point for improving the quality of care. For these broad reasons, and for its vital importance in reducing deaths due to lung disease in 2010: Year of the Lung, oxygen deserves a higher priority on the global health agenda.
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Affiliation(s)
- T Duke
- Centre for International Child Health, Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
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Blaauw D, Erasmus E, Pagaiya N, Tangcharoensathein V, Mullei K, Mudhune S, Goodman C, English M, Lagarde M. Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment. Bull World Health Organ 2010; 88:350-6. [PMID: 20461141 PMCID: PMC2865663 DOI: 10.2471/blt.09.072918] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [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: 10/01/2009] [Revised: 01/29/2010] [Accepted: 02/10/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the relative effectiveness of different policies in attracting nurses to rural areas in Kenya, South Africa and Thailand using data from a discrete choice experiment (DCE). METHODS A labelled DCE was designed to model the relative effectiveness of both financial and non-financial strategies designed to attract nurses to rural areas. Data were collected from over 300 graduating nursing students in each country. Mixed logit models were used for analysis and to predict the uptake of rural posts under different incentive combinations. FINDINGS Nurses' preferences for different human resource policy interventions varied significantly between the three countries. In Kenya and South Africa, better educational opportunities or rural allowances would be most effective in increasing the uptake of rural posts, while in Thailand better health insurance coverage would have the greatest impact. CONCLUSION DCEs can be designed to help policy-makers choose more effective interventions to address staff shortages in rural areas. Intervention packages tailored to local conditions are more likely to be effective than standardized global approaches.
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Affiliation(s)
- D Blaauw
- Centre for Health Policy, University of the Witwatersrand, Private Bag X3, Johannesburg, 2050, South Africa.
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Abstract
BACKGROUND With increasing survival rates for childhood cancer, late effects are of growing importance. Oral health is central to general health, level of nutrition, quality of life, and is significant in the holistic care of children during cancer therapy. HYPOTHESIS The oral health needs of children treated for solid tumours/lymphoma will be greater than the general population, groups will differ according to tumour and treatment. DESIGN One hundred and twenty patients, 0-17 years, under follow-up from 01/07/06 to 07/02/07 were investigated for caries, opacities, microdontia, and gingivitis. Analysis was performed with stratification according to tumour and treatment. Comparisons made with the UK 2003 Child Dental Health Survey. RESULTS The neuroblastoma group and high-dose chemotherapy with stem-cell rescue (HDCSCR) therapy group had increased caries of the primary teeth. Chi-squared analysis revealed a statistically significant relationship (P < 0.03) between the age at receipt of chemotherapy (<3.5 years) and the presence of microdont teeth. CONCLUSION Oral health care is important for all patients particularly those with a neuroblastoma, or who received HDCSCR. Patients should be advised about the possibility of microdontia in the permanent dentition following chemotherapy under 3.5 years.
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Affiliation(s)
- Alison Hutton
- Dental Specialties Department, Birmingham Children's Hospital, Birmingham UK.
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