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Reiter AJ, Huang L, Craig BT, Davidoff AM, Talbot LJ, Coggins J, Smith J, Aldrink JH, Bergus KC, MacArthur TA, Polites SF, Boehmer C, Brungardt J, Malek MM, Rinehardt HN, Kastenberg ZJ, Arkin CM, Gourmel A, Piche N, Wallace M, Liang J, Lovvorn HN, Petroze RT, Gillies G, Marquart JP, Becktell K, Le HD, Favela J, Rich BS, Glick RD, Seemann NM, Davidson J, Wilson CA, Roach J, Brown EG, Doyle KE, Coakley BA, Emengo P, Merola P, Grant CN, Tirumani A, Tracy ET, Moya-Mendez ME, Dasgupta R, Lautz TB. Survival outcomes in pediatric patients with metastatic Ewing sarcoma who achieve a rapid complete response of pulmonary metastases. Pediatr Blood Cancer 2024:e31026. [PMID: 38679864 DOI: 10.1002/pbc.31026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/26/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Our objectives were to compare overall survival (OS) and pulmonary relapse between patients with metastatic Ewing sarcoma (EWS) at diagnosis who achieve rapid complete response (RCR) and those with residual pulmonary nodules after induction chemotherapy (non-RCR). PATIENTS AND METHODS This retrospective cohort study included children under 20 years with metastatic EWS treated from 2007 to 2020 at 19 institutions in the Pediatric Surgical Oncology Research Collaborative. Chi-square tests were conducted for differences among groups. Kaplan-Meier curves were generated for OS and pulmonary relapse. RESULTS Among 148 patients with metastatic EWS at diagnosis, 61 (41.2%) achieved RCR. Five-year OS was 71.2% for patients who achieved RCR, and 50.2% for those without RCR (p = .04), and in multivariable regression among patients with isolated pulmonary metastases, RCR (hazards ratio [HR] 0.42; 95% confidence interval [CI]: 0.17-0.99) and whole lung irradiation (WLI) (HR 0.35; 95% CI: 0.16-0.77) were associated with improved survival. Pulmonary relapse occurred in 57 (37%) patients, including 18 (29%) in the RCR and 36 (41%) in the non-RCR groups (p = .14). Five-year pulmonary relapse rates did not significantly differ based on RCR (33.0%) versus non-RCR (47.0%, p = .13), or WLI (38.8%) versus no WLI (46.0%, p = .32). DISCUSSION Patients with EWS who had isolated pulmonary metastases at diagnosis had improved OS if they achieved RCR and received WLI, despite having no significant differences in rates of pulmonary relapse.
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Affiliation(s)
- Audra J Reiter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn Huang
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian T Craig
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Lindsay J Talbot
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jordan Coggins
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jasmine Smith
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Katherine C Bergus
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | | | - Chloe Boehmer
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Joseph Brungardt
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hannah N Rinehardt
- Division of Pediatric General and Thoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, Department of Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Cameron M Arkin
- Division of Pediatric Surgery, Department of Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Antoine Gourmel
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Nelson Piche
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Marshall Wallace
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University, Nashville, Tennessee, USA
| | - Jiancong Liang
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University, Nashville, Tennessee, USA
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University, Nashville, Tennessee, USA
| | - Robin T Petroze
- Division of Pediatric Surgery, University of Florida, Gainesville, Florida, USA
| | - Gwendolyn Gillies
- Division of Pediatric Surgery, University of Florida, Gainesville, Florida, USA
| | - John P Marquart
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kerri Becktell
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Hau D Le
- Division of Pediatric Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Juan Favela
- Division of Pediatric Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, New York, USA
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, New York, USA
| | - Natashia M Seemann
- Division of Paediatric Surgery, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Jacob Davidson
- Division of Paediatric Surgery, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Claire A Wilson
- Division of Paediatric Surgery, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Jonathan Roach
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Erin G Brown
- Division of Pediatric Surgery, University of California Davis, Sacramento, California, USA
| | - Kathleen E Doyle
- Division of Pediatric Surgery, University of California Davis, Sacramento, California, USA
| | - Brian A Coakley
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pamela Emengo
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pamela Merola
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christa N Grant
- Division of Pediatric Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Anuritha Tirumani
- Division of Pediatric Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Duke Children's Hospital and Health Center, Durham, North Carolina, USA
| | - Mary E Moya-Mendez
- Division of Pediatric Surgery, Duke Children's Hospital and Health Center, Durham, North Carolina, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Timothy B Lautz
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Wang AW, Emengo P, Taye A, Sharif Khawaja U, Levy CJ, Gallagher EJ. PSAT215 Hypercalcemic Crisis Complicating a First Trimester Pregnancy Caused by a Giant Parathyroid Adenoma Masquerading as a Thyroid Nodule. J Endocr Soc 2022. [PMCID: PMC9629358 DOI: 10.1210/jendso/bvac150.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Primary hyperparathyroidism (PHP) during pregnancy is rare with a reported incidence of 1%, although the true incidence is unknown. It is associated with increased morbidity and mortality for both mother and fetus. Most reported cases of PHP during pregnancy are due to small adenomas causing mild hyperparathyroidism. Surgical management is recommended if the calcium level is >11mg/dL (2.75mmol/L) or the patient has symptomatic hypercalcemia. It is generally recommended that surgery be performed in the second trimester due to the risk of miscarriage in the first trimester, and preterm labor in the third trimester. Case A 29-year-old woman presented to our emergency department at 10 weeks’ gestation with nausea and vomiting. She also reported constipation and fatigue. On examination, she was euvolemic, awake and alert, with no neurological symptoms or signs. The suspected diagnosis was hyperemesis gravidarum until her laboratory evaluation revealed marked hypercalcemia [15.6mg/d (3.9mmol/L)]. Further labs revealed hypophosphatemia [1.2mg/dL (0.39mmol/L)], hypokalemia [3.3mEq/L], hypomagnesemia [1.4mEq/L], low 25-hydroxy vitamin D [16.2ng/mL (40.44pmol/L)], and elevated intact parathyroid hormone (iPTH) [573pg/mL], 1,25-dihydroxy vitamin D [251.1pg/mL (626.75pmol/L)], and 24 hour urinary calcium [448mg/24 hours (11.2mmol/24 hours]. On cardiac evaluation, her QTc was normal. The patient was given intravenous hydration with normal saline, which reduced the calcium to 13.6mg/dL (3.4mmol/L) after 48 hours. She remained symptomatic and severely hypercalcemic, so calcitonin 4 IU/kg every 12 hours was added, while a neck ultrasound was performed to localize the parathyroid adenoma. Her calcium level decreased to 10.7mg/dL (2.7mmol/L) after calcitonin, but rapidly rebounded to 13.3mg/dL (3.3mmol/L) along with hypophosphatemia and hypokalemia. Intravenous potassium phosphate was initiated and her calcium decreased to 11.8mg/dL (2.95mmol/L). The neck ultrasound did not identify a parathyroid adenoma, but identified a 2.5×1.5×3.3 cm right mixed cystic/ solid thyroid nodule. An MRI of the neck revealed two right thyroid nodules. The decision was made to perform a neck dissection given the persistent severe hypercalcemia after a multidisciplinary team evaluation, and extensive discussion with the patient. The surgical exploration of the right neck identified a giant parathyroid adenoma that weighed 11.3g. The intraoperative PTH levels reduced from 804pg/mL to 60.7pg/mL. Her calcium normalized immediately postoperatively and she was discharged home without complication. At the time of last follow up, she was 18 weeks’ gestation and a fetal ultrasound was normal. Discussion This case had three unusual features: PHP causing severe hypercalcemia during pregnancy; a giant parathyroid adenoma; and parathyroid adenoma masquerading as a thyroid nodule on imaging. This case highlights the importance of a multidisciplinary team approach in optimizing the care of such complicated patients, along with the need for definitive surgical intervention. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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