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Beckhaus J, Friedrich C, Müller HL. Childhood-onset Craniopharyngioma-a Life-long Family Burden? J Clin Endocrinol Metab 2024; 109:e1404-e1405. [PMID: 37847153 DOI: 10.1210/clinem/dgad613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Julia Beckhaus
- Department of Pediatrics and Pediatric Hematology/Oncology, Klinikum Oldenburg AöR, University Children's Hospital, Carl von Ossietzky University Oldenburg, 26133 Oldenburg, Germany
- Division of Epidemiology and Biometry, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, Klinikum Oldenburg AöR, University Children's Hospital, Carl von Ossietzky University Oldenburg, 26133 Oldenburg, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, Klinikum Oldenburg AöR, University Children's Hospital, Carl von Ossietzky University Oldenburg, 26133 Oldenburg, Germany
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Bischoff M, Khalil DA, Frisch S, Bäcker CM, Peters S, Friedrich C, Tippelt S, Kortmann RD, Bison B, Müller HL, Timmermann B. Outcome After Modern Proton Beam Therapy in Childhood Craniopharyngioma: Results of the Prospective Registry Study KiProReg. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00432-2. [PMID: 38492813 DOI: 10.1016/j.ijrobp.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/24/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Craniopharyngiomas (CPs) are rare tumors of the sellar region often leading to significant comorbidities due to their close proximity to critical structures. The aim of this study was to analyze survival outcome and late toxicities after surgery and proton beam therapy (PBT) in childhood CPs. METHODS AND MATERIALS Within the prospective registry study "KiProReg" (DRKS0000536), data of 74 childhood patients with CP, receiving PBT between August 2013 to June 2022 were eligible. Late toxicities were analyzed according to the grading system of the Common Terminology Criteria for Adverse Events, version 4.0. RESULTS Median follow-up since first diagnosis was 4.3 years (range, 0.8-14.7). In addition, 75.7% of patients received PBT at time of disease progression or recurrence, whereas 24.3% as part of their primary therapy (definitive or adjuvant). Predominantly (85.1%), pencil beam scanning technique was used. The median total dose and initial tumor volume were 5400 cGy relative biologic effectiveness (RBE) and 17.64 cm³ (range, 3.07-300.59), respectively. The estimated (±SE) 3-year overall survival, progression-free, and cystic failure-free survival rate after PBT were 98.2% (±1.7), 94.7% (±3.0), and 76.8% (±5.4), respectively. All local failures (n = 3) were in-field relapses necessitating intervention and occurred exclusively in patients receiving PBT at progression or recurrence. Early cystic enlargements after PBT were typically asymptomatic and self-limiting. Fatigue, headaches, vision disorders, obesity, and endocrinopathies were the predominant late toxicities. No high-grade (≥3) new-onset visual impairment or cognitive deterioration occurred compared with baseline. The presence of cognitive impairments at the end of follow-up correlated with size of the planning target volume (P = .034), Dmean dose to the temporal lobes (P = .032, P = .045) and the number of surgical interventions before PBT (P = .029). CONCLUSIONS Our findings demonstrate favorable local control rates using modern PBT with acceptable late toxicities. Cyst growth within 12 months after radiation therapy is typically not associated with tumor progression. Longer follow-up must be awaited to confirm results.
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Affiliation(s)
- Martin Bischoff
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Essen, Germany; Department of Radiation Oncology, Ruhr-University Bochum, Medical Faculty, Marien Hospital, Herne, Germany.
| | - Dalia Ahmad Khalil
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Essen, Germany
| | - Sabine Frisch
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Essen, Germany
| | - Claus M Bäcker
- West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Essen, Germany
| | - Sarah Peters
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Essen, Germany
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Stephan Tippelt
- Department of Pediatrics III, Pediatric Oncology and Hematology, University Hospital Essen, Essen, Germany
| | | | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Essen, Germany; German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, Essen, Germany
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Beckhaus J, Boekhoff S, Scheinemann K, Schilling FH, Fleischhack G, Binder G, Bison B, Pietsch T, Friedrich C, Müller HL. Perinatally diagnosed congenital craniopharyngiomas in the KRANIOPHARYNGEOM trials. Endocr Connect 2023; 12:e230294. [PMID: 37878777 PMCID: PMC10692685 DOI: 10.1530/ec-23-0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/25/2023] [Indexed: 10/27/2023]
Abstract
Background Craniopharyngiomas (CPs) are rare embryonic tumors. Clinical presentation and outcome of patients perinatally diagnosed with congenital CP (cCP) are not clear and refer mainly to a few case reports in the literature. The aim of this study was to analyze clinical presentation and outcome in patients with cCP. Study design Three hundred and sixty-one patients diagnosed with adamantinomatous CP were recruited 2007-2022 in KRANIOPHARYNGEOM 2007/Registry 2019 and prospectively observed. In two cases, cCP was diagnosed prenatally and in one case on the second day of life. Pre- and perinatal diagnostic findings, postnatal evaluation, and therapeutic interventions and outcome in these three cases of cCP were analyzed. Results All patients survived. One patient developed psychomotor retardation and a mild hemiparesis. Prenatal routine ultrasound examination led to the diagnosis of cCP. Tumor resection was performed during the early postnatal period (range: 11-51 days of age). Functional capacity, measured by Fertigkeitenskala-Münster-Heidelberg (FMH) was reduced in three and behavioral parameters, measured by the Strength and Difficulties Questionnaire (SDQ) were abnormal in two cases. Conclusion cCP is a rare diagnosis with a prevalence of 0.83% in our study group. Compared to cases reported in the literature, the presented cases were treated immediately and had a better prognosis. Based on improvements of diagnostic and therapeutic techniques, prenatal diagnosis of cCP should lead to transfer prior to delivery of cCP patients to a specialized center for delivery and postnatal treatment of newborns with sellar masses by a multidisciplinary team to secure the improved prognosis of these patients. Significance statement We previously reported that lower event-free survival rates after craniopharyngioma are associated with younger age at diagnosis. Perinatally diagnosed congenital craniopharyngiomas are very rare. This article presents three unique cases with congenital craniopharyngioma, comparing their diagnostics, therapy, and development. All three cases had surgery during the early postnatal period with sparing of the posterior hypothalamus. In each case, endocrinopathy was present at follow-up. Low functional capacity was reported in all cases and an abnormal total difficulties score in two cases. Compared to the literature, the presented cases had better prognosis in morbidity and mortality. This report and the review of the literature confirm the importance of a multidisciplinary approach in the diagnostic and treatment of the very rare condition of congenital craniopharyngioma.
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Affiliation(s)
- Julia Beckhaus
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany
- Division of Epidemiology and Biometry, Carl von Ossietzky University, Oldenburg, Germany
| | - Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Katrin Scheinemann
- Pediatric Hematology-Oncology Center, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Pediatrics, McMaster Children’s Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Freimut H Schilling
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Children’s Hospital Lucerne, Lucerne, Switzerland
| | | | - Gerhard Binder
- University Children’s Hospital, Pediatric Endocrinology, University Tübingen, Tübingen, Germany
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany
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Sowithayasakul P, Beckhaus J, Boekhoff S, Friedrich C, Calaminus G, Müller HL. Vision-related quality of life in patients with childhood-onset craniopharyngioma. Sci Rep 2023; 13:19599. [PMID: 37949931 PMCID: PMC10638396 DOI: 10.1038/s41598-023-46532-y] [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: 04/21/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
Quality of life (QoL) is a critical component of aftercare in survivors of childhood-onset craniopharyngioma (CP). Visual impairment adversely affects QoL after CP. This study assessed the frequency of visual impairment in patients with CP and its association with QoL. This study analyzed vision-related QoL in patients recruited 2000-2019 in the prospective cohort studies KRANIOPHARYNGEOM 2000/2007. Ophthalmologic examinations were performed at diagnosis, three, 12, and 36 months, respectively after the diagnosis. The QoL (PEDQOL) scores, were also evaluated at three, 12, and 36 months, respectively after the CP diagnosis. Multivariable logistic regression was used to analyze factors associated with visual impairment during follow-up. One-hundred twenty patients were included in this study. On ophthalmological examination, visual impairment was observed in the majority of the patients (n = 84, 70%) at CP diagnosis. After surgery, vision was restored in 27 patients (32%) with visual impairment at diagnosis. In the first (p = 0.017) and third (p = 0.011) year after diagnosis, parents of patients with visual impairment reported lower social functioning (family). Reduced autonomy was found three years after diagnosis in self- (p = 0.029) and parental (p = 0.048) assessments. Next to visual impairment at diagnosis, no additional risk factors for visual impairment during follow-up could be identified. Visual impairment has a clinically relevant impact on QoL after CP. The visual status at CP diagnosis determines the visual outcome during follow-up. Early detection of visual impairment, regular QoL assessments, and risk-appropriate aftercare are recommended.Clinical Trial Registration KRANIOPHARYNGEOM 2000 (Clinical trial registration number: NCT00258453) and KRANIOPHARYNGEOM 2007 (Clinical trial registration number: NCT01272622).
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Affiliation(s)
- Panjarat Sowithayasakul
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl Von Ossietzky University, Klinikum Oldenburg AöR, Rahel-Straus-Strasse 10, 26133, Oldenburg, Germany
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Julia Beckhaus
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl Von Ossietzky University, Klinikum Oldenburg AöR, Rahel-Straus-Strasse 10, 26133, Oldenburg, Germany
- Division of Epidemiology and Biometry, Carl Von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl Von Ossietzky University, Klinikum Oldenburg AöR, Rahel-Straus-Strasse 10, 26133, Oldenburg, Germany
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl Von Ossietzky University, Klinikum Oldenburg AöR, Rahel-Straus-Strasse 10, 26133, Oldenburg, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology/Oncology, University of Bonn Medical Center, Bonn, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl Von Ossietzky University, Klinikum Oldenburg AöR, Rahel-Straus-Strasse 10, 26133, Oldenburg, Germany.
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Friedrich C, Boekhoff S, Bischoff M, Beckhaus J, Sowithayasakul P, Calaminus G, Eveslage M, Valentini C, Bison B, Harrabi SB, Krause M, Timmermann B, Müller HL. Outcome after proton beam therapy versus photon-based radiation therapy in childhood-onset craniopharyngioma patients-results of KRANIOPHARYNGEOM 2007. Front Oncol 2023; 13:1180993. [PMID: 37965466 PMCID: PMC10641508 DOI: 10.3389/fonc.2023.1180993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background Proton beam therapy (PBT) is being increas16ingly used to treat residual craniopharyngioma (CP) after hypothalamus-sparing surgery. Compared to photon-based radiation therapy (XRT) with PBT, less irradiation in the penumbra reduces the scattered dose to critical organs neighboring but outside the area of treatment, minimizing the risk of sequelae. Patients and methods Between 2007 and 2019, 99 of 290 (34%) childhood-onset CP patients recruited in KRANIOPHARYNGEOM 2007 received external radiation therapy (RT) (65% PBT, 35% XRT). Outcome was analyzed in terms of survival, endocrinological and anthropometric parameters (BMI and height SDS), quality of life (QoL using PEDQOL), and functional capacity (FMH) with special regard to irradiation technique. Results PBT became predominant (used in 43% and 72% of all irradiated patients registered within the first and second halves of the recruitment period, between 2008 and 2013 and 2013 and 2018, respectively). Five-year event-free survival rates after PBT or XRT were comparable (92% ± 4% vs. 91% ± 4%, p = 0.42) and higher than for the whole cohort since diagnosis, including non-RT patients (37% ± 4%). Radiation doses to the hypothalamus and pituitary did not differ between PBT and XRT. Endocrine deficits due to disturbances of the hypothalamic-pituitary axis (HPA) were already common before irradiation. During the first 5 years after CP diagnosis/RT, no differences between PBT, XRT, and non-RT CP patients concerning functional capacity and anthropometric parameters have been obtained. Only for the PEDQOL domain "physical function", parental-assessed QoL was lower 12 months after PBT versus XRT or non-RT patients. Conclusion QoL, functional capacity, degree of obesity, and endocrinopathy varied over time from diagnosis, but by 5 years, there was no significant difference between PBT and XRT upfront or delayed, nor was there any compromise in historic survival rates, which remained high >90%. RT of any type is extremely effective at stabilizing disease after hypothalamic-sparing surgery. The purported specific benefits of PBT-reducing sequelae are not proven in this study where the organ of critical interest is itself diseased, increasing an urgent need to better address and treat the tumor-induced endocrine harm from diagnosis in dedicated pituitary services. Other hypothesized benefits of PBT versus XRT on vascular events and secondary cancers await longer comparison. Clinical trial registration number https://clinicaltrials.gov/study/, identifier NCT01272622.
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Affiliation(s)
- Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Martin Bischoff
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany
| | - Julia Beckhaus
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Panjarat Sowithayasakul
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Gabriele Calaminus
- Department of Pediatric Hematology/Oncology, University of Bonn Medical Center, Bonn, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Chiara Valentini
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Semi B. Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Mechthild Krause
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT) Dresden with German Cancer Research Center (DKFZ), University Hospital and Faculty of Medicine Dresden, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ) Heidelberg, Dresden, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ) and German Cancer Consortium (DKTK), Essen, Germany
| | - Hermann L. Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
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Wagener K, Beckhaus J, Boekhoff S, Friedrich C, Müller HL. Publisher Correction to: Sporadic and neurofibromatosis type 2-associated meningioma in children and adolescents. J Neurooncol 2023; 164:503. [PMID: 37644230 DOI: 10.1007/s11060-023-04424-1] [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: 08/31/2023]
Affiliation(s)
- Katharina Wagener
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University of Oldenburg, Klinikum Oldenburg AöR, 26133, Oldenburg, Germany
| | - Julia Beckhaus
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University of Oldenburg, Klinikum Oldenburg AöR, 26133, Oldenburg, Germany
- Division of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, 26129, Oldenburg, Germany
| | - Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University of Oldenburg, Klinikum Oldenburg AöR, 26133, Oldenburg, Germany
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University of Oldenburg, Klinikum Oldenburg AöR, 26133, Oldenburg, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University of Oldenburg, Klinikum Oldenburg AöR, 26133, Oldenburg, Germany.
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Tonn S, Korshunov A, Obrecht D, Sill M, Spohn M, von Hoff K, Milde T, Pietsch T, Goschzik T, Bison B, Juhnke BO, Struve N, Sturm D, Sahm F, Bockmayr M, Friedrich C, von Bueren AO, Gerber NU, Benesch M, Jones DTW, Kool M, Wefers AK, Schüller U, Pfister SM, Rutkowski S, Mynarek M. Risk prediction in early childhood sonic hedgehog medulloblastoma treated with radiation-avoiding chemotherapy: Evidence for more than 2 subgroups. Neuro Oncol 2023; 25:1518-1529. [PMID: 36715306 PMCID: PMC10398808 DOI: 10.1093/neuonc/noad027] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The prognostic impact of clinical risk factors and DNA methylation patterns in sonic hedgehog (SHH)-activated early childhood desmoplastic/nodular medulloblastoma (DMB) or medulloblastoma with extensive nodularity (MBEN) were evaluated to better identify patients at risk for relapse. METHODS One hundred and forty-four patients with DMB (n = 99) or MBEN (n = 45) aged <5 years and treated with radiation-sparing approaches, including intraventricular methotrexate in 132 patients were evaluated. RESULTS Patients with DMB had less favorable 5-year progression-free survival than MBEN (5y-PFS, 71% [DMB] vs. 93% [MBEN]). Patients aged >3 years were associated with more unfavorable 5y-PFS (47% [>3 years] vs. 85% [<1 year] vs. 84% [1-3 years]). DNA methylation profiles available (n = 78) were reclassified according to the 2021 WHO classification into SHH-1 (n = 39), SHH-2 (n = 38), and SHH-3 (n = 1). Hierarchical clustering delineated 2 subgroups among SHH-2: SHH-2a (n = 19) and SHH-2b (n = 19). Patients with SHH-2b medulloblastoma were older, predominantly displayed DMB histology, and were more often located in the cerebellar hemispheres. Chromosome 9q losses were more frequent in SHH-2b, while few chromosomal alterations were observed in SHH-2a. SHH-2b medulloblastoma carried a significantly increased relapse risk (5y-PFS: 58% [SHH-2b] vs. 83% [SHH-1] vs. 95% [SHH-2a]). Subclassification of SHH-2 with key clinical and cytogenetic characteristics was confirmed using 2 independent cohorts (total n = 188). Gene mutation analysis revealed a correlation of SHH-2a with SMO mutations. CONCLUSIONS These data suggest further heterogeneity within early childhood SHH-DMB/MBEN: SHH-2 splits into a very low-risk group SHH-2a enriched for MBEN histology and SMO mutations, and SHH-2b comprising older DMB patients with a higher risk of relapse.
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Affiliation(s)
- Svenja Tonn
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology (B300), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Denise Obrecht
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Sill
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg, Germany
- Research Institute Children’s Cancer Center Hamburg, Hamburg, Germany
| | - Michael Spohn
- Bioinformatics Core Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Pediatric Oncology and Hematology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Till Milde
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Tobias Goschzik
- Institute of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Brigitte Bison
- Diagnostic and interventional Neuroradiology, Faculty of Medicine, University Hospital Augsburg, Augsburg, Germany
- Neuroradiological Reference Center for the pediatric brain tumor (HIT) studies of the German Society of Pediatric Oncology and Hematology, University Hospital Wuerzburg, Wuerzburg, Germany (until 2020)
- University Augsburg, Faculty of Medicine, Augsburg, Germany (since 2021), Germany
| | - Björn-Ole Juhnke
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Struve
- Department of Radiotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominik Sturm
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Sahm
- Clinical Cooperation Unit Neuropathology (B300), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Michael Bockmayr
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center Hamburg, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany
| | - André O von Bueren
- Division of Pediatric Oncology and Hematology, Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
- CANSEARCH research platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Nicolas U Gerber
- Department of Oncology, University Children’s Hospital, Zurich, Switzerland
| | - Martin Benesch
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - David T W Jones
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Glioma Research (B360), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Kool
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg, Germany
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Annika K Wefers
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center Hamburg, Hamburg, Germany
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan M Pfister
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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8
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Eide M, Jussli-Melchers J, Friedrich C, Haneya A, Lutter G, Cremer J, Schoettler J. Surgical Myocardial Revascularization with a Composite T-graft from the Left Internal Mammary Artery-Comparison of the Great Saphenous Vein with the Radial Artery. Thorac Cardiovasc Surg 2023. [PMID: 37506730 DOI: 10.1055/s-0043-1771358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
BACKGROUND Composite T-grafts between left internal mammary artery (LIMA) and radial artery (RA) are a common concept in complete arterial myocardial revascularization. The aim of the present study was to investigate whether the use of the great saphenous vein (SV) instead of RA leads to comparably good results in terms of outcome in this context. METHODS Patients who underwent myocardial revascularization with a T-graft using RA or a segment of SV to the right coronary artery or circumflex artery between the beginning of 2014 and the end of 2019 at the Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel were included. To minimize surgical variation, only patients were observed by a single senior surgeon in the department. Exclusion criteria were previous cardiac surgery, preoperative extracorporeal circulatory support, off-pump surgery, additional aortocoronary bypasses, and cardiac combination procedures. RESULTS A total of 115 patients were studied. In 55 patients, the T-graft was placed between the LIMA and SV, and in 60 patients, the T-graft was placed between the LIMA and RA. Patients in the SV group were older (70.6 ± 7.8 vs. 58.5 ± 10.0 years; p < 0.001), suffered more frequently from non-ST elevation myocardial infarction (12.7 vs. 1.7%; p = 0.027), arterial hypertension (83.6 vs. 61.7%; p = 0.009), and atrial fibrillation (18.2 vs. 1.7%; p = 0.003). They were less likely to be active smokers (16.4 vs. 38.3%; p = 0.009) and less likely to have a history of variceal surgery (0 vs. 15.0%; p = 0.003). Calcification of the ascending aorta was also found more frequently in the saphenous group (18.2 vs. 3.3%, p = 0.009). Operative times and number of distal anastomoses did not differ significantly between the two groups. Postoperative deliriums (16.7 vs. 5.0%; p = 0.043) were observed more frequently in venous patients. Wound healing disorders of the leg (11.1 vs. 0%; p = 0.011) did only occur in SV group and wound infections of the arm only in the RA group. Complete follow-up was achieved in 74.8% of cases. Median follow-up was 60.3 (39.6; 73.2) months. Serious adverse cardiac-cerebral events (19.0 vs. 22.7%; p = 0.675) and mortality (14.5 vs. 6.7%; p = 0.167) did not differ significantly between the groups at follow-up. Myocardial infarction (0 vs. 2.5%; p = 1.000) and stroke (0 vs. 7.5%; p = 0.245) were observed exclusively in RA group. Percutaneous coronary intervention was required in single patients of RA group (0 vs. 15.0%; p = 0.028). No patient from either group underwent repeat coronary artery bypass grafting (CABG). The patients of SV group had angiographically competent grafts and open anastomoses. Graft failure was noted in a single patient in RA group, in which case both grafts and native coronary vessels were stented. Kaplan-Meier analysis revealed no significant survival disadvantage for SV group compared with RA group. CONCLUSION CABG with a composite T-graft between LIMA and a segment of SV may be comparable to bypass surgery with a composite T-graft between LIMA and RA. This might be true in terms of morbidity and mortality over an intermediate-term observation period. The results of our studies give rise to the hypothesis that the decision not to perform aortic bypass anastomosis may be more important than the choice of graft material.
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Affiliation(s)
- M Eide
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - J Jussli-Melchers
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - C Friedrich
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - A Haneya
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - G Lutter
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - J Cremer
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - J Schoettler
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
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9
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Wagener K, Beckhaus J, Boekhoff S, Friedrich C, Müller HL. Sporadic and neurofibromatosis type 2-associated meningioma in children and adolescents. J Neurooncol 2023; 163:555-563. [PMID: 37402092 DOI: 10.1007/s11060-023-04344-0] [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: 04/25/2023] [Accepted: 05/13/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Pediatric meningioma differs not only in its rare incidence from the adult meningioma, but also in its clinical characteristics. Many treatment approaches of pediatric meningioma are based on the study results of adult meningioma studies. The aim of this study was to explore the clinical and epidemiological characteristics of pediatric meningioma. METHODS Data on pediatric patients diagnosed between 1982 and 2021 with NF2-associated or sporadic meningioma and recruited in the trials/registries HIT-ENDO, KRANIOPHARYNGEOM 2000/2007 and KRANIOPHARYNGEOM Registry 2019 were retrospectively analyzed for clinical characteristics, etiology, histology, therapy, and outcome. RESULTS One hundred fifteen study participants were diagnosed with sporadic or NF2-associated meningioma at a median age of 10.6 years. There was a 1:1 sex ratio, with 14% of study participants suffering from NF2. 46% of the meningiomas were located hemispherically, 17% at the optic nerve/ intraorbital and 10% ventricularly. Multiple meningiomas were detected in 69% of NF2 patients and in 9% of sporadic meningiomas. 50% of the meningiomas were WHO grade I, 37% WHO grade II and 6% WHO grade III. Progressions or recurrences occurred after a median interval of 1.9 years. Eight patients (7%) died, 3 of them due to disease. The event-free survival was higher for WHO grade I than for WHO grade II meningioma patients (p = 0.008). CONCLUSIONS The major difference to the preceding literature could be found in the distribution of different WHO grades and their influence on event-free survival. Prospective studies are warranted to assess the impact of different therapeutic regimens. CLINICAL TRIAL REGISTRATION NUMBERS NCT00258453; NCT01272622; NCT04158284.
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Affiliation(s)
- Katharina Wagener
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University of Oldenburg, Klinikum Oldenburg AöR, 26133, Oldenburg, Germany
| | - Julia Beckhaus
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University of Oldenburg, Klinikum Oldenburg AöR, 26133, Oldenburg, Germany
- Division of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, 26129, Oldenburg, Germany
| | - Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University of Oldenburg, Klinikum Oldenburg AöR, 26133, Oldenburg, Germany
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University of Oldenburg, Klinikum Oldenburg AöR, 26133, Oldenburg, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University of Oldenburg, Klinikum Oldenburg AöR, 26133, Oldenburg, Germany.
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10
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Beckhaus J, Friedrich C, Boekhoff S, Calaminus G, Bison B, Eveslage M, Timmermann B, Flitsch J, Müller HL. Outcome after pediatric craniopharyngioma: the role of age at diagnosis and hypothalamic damage. Eur J Endocrinol 2023; 188:7060061. [PMID: 36857103 DOI: 10.1093/ejendo/lvad027] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Craniopharyngiomas (CP) are rare malformational tumors. Clinical presentation and outcome of pediatric patients with CP with specific regard to age at diagnosis is not clear. The aim of this cohort study was to determine clinical presentation and outcome in these patients diagnosed at different ages at diagnosis. DESIGN Seven hundred and nine patients diagnosed with CP were recruited from 1999 to 2021 in HIT-Endo and KRANIOPHARYNGEOM 2000/2007/Registry 2019 and prospectively observed. METHODS Age at diagnosis was categorized as infants and toddlers (<2 years), early childhood (2-6 years), middle childhood (6-12 years), and early adolescence (12-18 years). Overall and event-free survival (EFS), functional capacity (FMH), and quality of life (QoL) (PEDQOL) were assessed. RESULTS Severe obesity (body mass index [BMI] >3 standard deviation score [SDS]) was prevalent in 45.4% at last visit. A lower EFS but better QoL was observed in children with age at diagnosis <6 years compared with ≥6 years. Reduced functional capacity percentiles were associated with increased BMI-SDS at last visit (rho = -0.125, 95% confidence interval [CI; -0.21; -0.04]) and age at diagnosis <2 years. Posterior hypothalamic involvement and hypothalamic lesion (HL) were independent risk factors for reduced EFS (hazard ratio = 1.59, 95% CI [1.12-2.26]) and obesity at last visit (odds ratio = 2.94, 95% CI [1.73-5.08]). Age at diagnosis did not contribute to severe obesity and reduced QoL. CONCLUSIONS Diagnosis of CP at age <6 years may help patients to adapt early to disabilities but may lead to a higher probability of CP relapse. Not age at diagnosis but posterior HL may be the contributing factor to severe obesity and a reduced QoL. CLINICAL TRIAL REGISTRATION NUMBERS NCT00258453; NCT01272622; NCT04158284.
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Affiliation(s)
- Julia Beckhaus
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg 26133, Germany
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg 26133, Germany
| | - Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg 26133, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology/Oncology, University of Bonn Medical Center, Bonn, Germany
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, Department of Neuroradiology, University Hospital of Augsburg, Augsburg, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, Essen, Germany
| | - Jörg Flitsch
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg 26133, Germany
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11
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Isler JR, Pini N, Lucchini M, Shuffrey LC, Morales S, Bowers ME, Leach SC, Sania A, Wang L, Condon C, Nugent JD, Elliott AJ, Friedrich C, Andrew R, Fox NA, Myers MM, Fifer WP. Longitudinal characterization of EEG power spectra during eyes open and eyes closed conditions in children. Psychophysiology 2023; 60:e14158. [PMID: 35968705 PMCID: PMC9729391 DOI: 10.1111/psyp.14158] [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: 07/27/2021] [Revised: 05/18/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
This study is the first to examine spectrum-wide (1 to 250 Hz) differences in electroencephalogram (EEG) power between eyes open (EO) and eyes closed (EC) resting state conditions in 486 children. The results extend the findings of previous studies by characterizing EEG power differences from 30 to 250 Hz between EO and EC across childhood. Developmental changes in EEG power showed spatial and frequency band differences as a function of age and EO/EC condition. A 64-electrode system was used to record EEG at 4, 5, 7, 9, and 11 years of age. Specific findings were: (1) the alpha peak shifts from 8 Hz at 4 years to 9 Hz at 11 years, (2) EC results in increased EEG power (compared to EO) at lower frequencies but decreased EEG power at higher frequencies for all ages, (3) the EEG power difference between EO and EC changes from positive to negative within a narrow frequency band which shifts toward higher frequencies with age, from 9 to 12 Hz at 4 years to 32 Hz at 11 years, (4) at all ages EC is characterized by an increase in lower frequency EEG power most prominently over posterior regions, (5) at all ages, during EC, decreases in EEG power above 30 Hz are mostly over anterior regions of the scalp. This report demonstrates that the simple challenge of opening and closing the eyes offers the potential to provide quantitative biomarkers of phenotypic variation in brain maturation by employing a brief, minimally invasive protocol throughout childhood.
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Affiliation(s)
- J. R. Isler
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032 USA
| | - N. Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032 USA
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032 USA
| | - M. Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032 USA
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032 USA
| | - L. C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032 USA
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032 USA
| | - S. Morales
- Department of Psychology, University of Southern California, Los Angeles, CA 90089 USA
| | - M. E. Bowers
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD 20742 USA
| | - S. C. Leach
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD 20742 USA
| | - A. Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032 USA
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032 USA
| | - L. Wang
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032 USA
- Data Science Institute, Columbia University, New York, NY 10027 USA
| | - C. Condon
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032 USA
| | - J. D. Nugent
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032 USA
| | | | - C. Friedrich
- Avera Research Institute, Sioux Falls, SD 57108 USA
| | - R. Andrew
- Avera Research Institute, Sioux Falls, SD 57108 USA
| | - N. A. Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD 20742 USA
| | - M. M. Myers
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032 USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032 USA
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032 USA
| | - W. P. Fifer
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032 USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032 USA
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032 USA
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12
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De Silva N, Salem M, Friedrich C, Diraz S, Broll A, Pommert NS, Puehler T, Schoettler J, Cremer J, Haneya A. Does Duration of Aortic Cross Clamp Affect Outcome in Patients Undergoing Surgical Repair of Acute Dissection of Aorta Type A? A Large Retrospective Cohort Study. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761659] [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: 03/22/2023]
Affiliation(s)
- N. De Silva
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - M. Salem
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - C. Friedrich
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - S. Diraz
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A. Broll
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - N. S. Pommert
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - T. Puehler
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - J. Schoettler
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - J. Cremer
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A. Haneya
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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13
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Boekhoff S, Eveslage M, Beckhaus J, Friedrich C, Müller HL. Anerkannter Grad der Behinderung (GdB) im Langzeitverlauf nach
Kraniopharyngeom im Kindes- und Jugendalter. Klin Padiatr 2022; 235:151-158. [PMID: 36379455 DOI: 10.1055/a-1952-9994] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Zusammenfassung
Hintergrund Kraniopharyngeome sind seltene embryonale Fehlbildungstumore
niedriger Malignität. Die Langzeitprognose nach Diagnose im Kindes- und
Jugendalter wird häufig durch (neuro)endokrine Spätfolgen
beeinträchtigt. Eine Anerkennung des Schwerbehindertenstatus mit
unterschiedlichen Graden der Behinderung (GdB) kann die psychosoziale
Integration erleichtern.
Patienten und Methoden 108 Patienten, die mit kindlichem Kraniopharyngeom
in der Studie HIT-Endo registriert wurden, konnten nach im Median 16 Jahren
Follow-up hinsichtlich des aktuellen GdB und assoziierter Faktoren wie
endokriner, ophthalmologischer, neuropsychologischer (QLQ-C30; MFI-20;
FMH-Skala) und psychosozialer Befunde ausgewertet werden.
Ergebnisse 47 Patienten (43%) hatten keine Anerkennung einer
Behinderung oder einen GdB 30–40, 43 Patienten (40%) einen GdB
50–90 und 18 Patienten (17%) einen GdB 100. Höhere GdB
waren assoziiert mit niedrigerem schulischen Bildungsniveau, höherem
BMI-SDS, einer höheren Rate an Sehbeeinträchtigungen und
hypothalamischer Beteiligung des Kraniopharyngeoms. Patienten mit einem GdB 100
litten häufiger an Einschränkungen der physischen und kognitiven
Funktion, Atemnot und Schmerzzuständen (QLQ-C30), sowie Fatigue
(MFI-20), und Einschränkungen im sozialen und beruflichen Kontext.
Patienten mit GdB 100 haben im Mittel eine herabgesetzte funktionelle
Kapazität (FMH Score) gegenüber Patienten mit niedrigerem
GdB.
Schlussfolgerungen Der anerkannte GdB zeigt sich assoziiert mit
psychosozialen und gesundheitlichen Einschränkungen im Langzeitverlauf
nach Kraniopharyngeom. Die funktionelle Kapazität zeigt im Mittel einen
großen Unterschied zwischen GdB 100 und niedrigerem GdB.
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Affiliation(s)
- Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology,
University Children’s Hospital, Klinikum Oldenburg AöR, Carl von
Ossietzky University Oldenburg, Oldenburg, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of
Münster, Muenster, Germany
| | - Julia Beckhaus
- Department of Pediatrics and Pediatric Hematology/Oncology,
University Children’s Hospital, Klinikum Oldenburg AöR, Carl von
Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology,
University Children’s Hospital, Klinikum Oldenburg AöR, Carl von
Ossietzky University Oldenburg, Oldenburg, Germany
| | - Hermann L. Müller
- Department of Pediatrics and Pediatric Hematology/Oncology,
University Children’s Hospital, Klinikum Oldenburg AöR, Carl von
Ossietzky University Oldenburg, Oldenburg, Germany
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14
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Wyrwoll MJ, Wabschke R, Röpke A, Wöste M, Ruckert C, Perrey S, Rotte N, Hardy J, Astica L, Lupiáñez DG, Wistuba J, Westernströer B, Schlatt S, Berman AJ, Müller AM, Kliesch S, Yatsenko AN, Tüttelmann F, Friedrich C. Analysis of copy number variation in men with non-obstructive azoospermia. Andrology 2022; 10:1593-1604. [PMID: 36041235 PMCID: PMC9605881 DOI: 10.1111/andr.13267] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent findings demonstrate that single nucleotide variants can cause non-obstructive azoospermia (NOA). In contrast, copy number variants (CNVs) were only analysed in few studies in infertile men. Some have reported a higher prevalence of CNVs in infertile versus fertile men. OBJECTIVES This study aimed to elucidate if CNVs are associated with NOA. MATERIALS AND METHODS We performed array-based comparative genomic hybridisation (aCGH) in 37 men with meiotic arrest, 194 men with Sertoli cell-only phenotype, and 21 control men. We filtered our data for deletions affecting genes and prioritised the affected genes according to the literature search. Prevalence of CNVs was compared between all groups. Exome data of 2,030 men were screened to detect further genetic variants in prioritised genes. Modelling was performed for the protein encoded by the novel candidate gene TEKT5 and we stained for TEKT5 in human testicular tissue. RESULTS We determined the cause of infertility in two individuals with homozygous deletions of SYCE1 and in one individual with a heterozygous deletion of SYCE1 combined with a likely pathogenic missense variant on the second allele. We detected heterozygous deletions affecting MLH3, EIF2B2, SLX4, CLPP and TEKT5, in one subject each. CNVs were not detected more frequently in infertile men compared with controls. DISCUSSION While SYCE1 and MLH3 encode known meiosis-specific proteins, much less is known about the proteins encoded by the other identified candidate genes, warranting further analyses. We were able to identify the cause of infertility in one out of the 231 infertile men by aCGH and in two men by using exome sequencing data. CONCLUSION As aCGH and exome sequencing are both expensive methods, combining both in a clinical routine is not an effective strategy. Instead, using CNV calling from exome data has recently become more precise, potentially making aCGH dispensable.
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Affiliation(s)
- M. J. Wyrwoll
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - R. Wabschke
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - A. Röpke
- Institute of Human Genetics, University of Münster, Münster, Germany
| | - M. Wöste
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - C. Ruckert
- Institute of Human Genetics, University of Münster, Münster, Germany
| | - S. Perrey
- Institute for Bioinformatics and Chemoinformatics, Westphalian University of Applied Sciences, Recklinghausen, Germany
| | - N. Rotte
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - J. Hardy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - L. Astica
- Epigenetics and Sex Development Group, Berlin Institute for Medical Systems Biology, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
| | - D. G. Lupiáñez
- Epigenetics and Sex Development Group, Berlin Institute for Medical Systems Biology, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
| | - J. Wistuba
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - B. Westernströer
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - S. Schlatt
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - A. J. Berman
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - A. M. Müller
- Practice for Pathology and Centre for Pediatric Pathology, University Hospital of Cologne, Cologne, Germany
| | - S. Kliesch
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - A. N. Yatsenko
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - F. Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - C. Friedrich
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
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15
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Boekhoff S, Bison B, Eveslage M, Friedrich C, Flitsch J, Müller HL. RARE-01. Cerebral infarction in childhood-onset craniopharyngioma patients: results of KRANIOPHARYNGEOM 2007. Neuro Oncol 2022. [PMCID: PMC9164754 DOI: 10.1093/neuonc/noac079.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND: Cerebral infarction (CI) is a known vascular complication following treatment of suprasellar tumors. Risk factors for CI, incidence rate, and long-term prognosis are unknown for patients with childhood-onset craniopharyngioma (CP). METHODS: MRI of 244 CP patients, recruited between 2007 and 2019 in KRANIOPHA-RYNGEOM 2007, were reviewed for CI. Risk factors for CI and outcome after CI were analyzed. RESULTS: Twenty-eight of 244 patients (11%) presented with CI based on reference assessment of MRI. One CI occurred before initial surgery and one case of CI occurred after release of intracystic pressure by a cyst catheter. 26 of 28 CI were detected after surgical tumor resection at a median postoperative interval of one day (range: 0.5 - 53 days). Vascular lesions during surgical procedures were documented in 7 cases with CI. No relevant differences with regard to surgical approaches were found. In all 12 irradiated patients, CI occurred before irradiation. Multivariable analyses showed that hydrocephalus and gross-total resection at the time of primary diagnosis / surgery both were risk factors for CI. After CI, quality of life (PEDQOL) and functional capacity (FMH) were impaired. CONCLUSIONS: CI occurs in 11% of surgically-treated CP cases. Degree of resection and increased intracranial pressure are risk factors, which should be considered in the planning of surgical procedures for prevention of CI.
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Affiliation(s)
- Svenja Boekhoff
- Dept. of Pediatrics and Pediatric Hematology/Oncology, University Chilrdren's Hospital, Klinikum Oldenburg AöR , Oldenburg , Germany
| | - Brigitte Bison
- Dept. of Neuroradiology, University of Augsburg , Augsburg , Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster , Münster , Germany
| | - Carsten Friedrich
- Dept. of Pediatrics and Pediatric Hematology/Oncology, University Chilrdren's Hospital, Klinikum Oldenburg AöR , Oldenburg , Germany
| | - Jörg Flitsch
- Dept. of Neurosurgery, University Hospital UKE , Hamburg , Germany
| | - Hermann L Müller
- Dept. of Pediatrics and Pediatric Hematology/Oncology, University Chilrdren's Hospital, Klinikum Oldenburg AöR , Oldenburg , Germany
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Flaßkühler AM, Friedrich C, Beckhaus J, Boekhoff S, Fiedler K, Becking MS, Hitz MP, Gieldon L, Spranger S, Bison B, Hoppe F, Müller HL. RARE-14. Newborn with hypothalamic hamartoma and Pallister-Hall syndrome. Neuro Oncol 2022. [PMCID: PMC9164883 DOI: 10.1093/neuonc/noac079.039] [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: 11/17/2022] Open
Abstract
A female full-term newborn of 41 + 2 weeks gestational age with a respiratory adaptation disorder and hypercapnia was transferred from an external maternity clinic to our pediatric intensive care unit. The child is the second child of healthy, non-consanguineous parents. Multiple dysmorphias were noticed at arrival. We identified a choanal atresia/stenosis on both sides in the respiratory tract, a high palate, a submucous cleft palate, a bifid uvula, a laryngeal cleft and a bronchus suis. The child required intubation and ventilation. In addition, we recognized brachydactyly of the hands and feet. The phalanges were not visibly separable. There was nail hypoplasia and rocker bottom feet on both sides. Furthermore, we saw an anal atresia. In routine laboratory work-up, a hypoglycemia and not measurable low TSH serum concentration was noticed. Extended endocrinological laboratory diagnostics revealed a complete pituitary insufficiency. On cranial MRI, a large, iso- to slightly hyperintense space-occupying mass (3.8x3.7x2.5 cm3), originating from the hypothalamus was observed. The brainstem was displaced posteriorly by the mass. The imaging is consistent with a hypothalamic hamartoma. With regard to the present findings, we assumed an underlying genetic cause of the congenital malformations. As a clinical diagnosis, a Pallister-Hall syndrome was suspected. As described in our case, we saw the characteristic features: dysmorphia of the hands and feet, upper respiratory tract, anal atresia, and hypothalamic hamartomas. The Pallister-Hall syndrome is caused by mutations in the GLI3 gene on the 7p13 chromosome. It is inherited in an autosomal dominant manner and its prevalence is unknown. In our patient, a heterozygous, probably pathogenic variant in the GLI3-Gene was proven by Next Generation Sequencing (NGS).
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Affiliation(s)
- Anna Meera Flaßkühler
- Dept. of Pediatrics and Pediatric Hematalogy / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Carsten Friedrich
- Dept. of Pediatrics and Pediatric Hematalogy / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Julia Beckhaus
- Dept. of Pediatrics and Pediatric Hematalogy / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Svenja Boekhoff
- Dept. of Pediatrics and Pediatric Hematalogy / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Kai Fiedler
- Dept. of Pediatric and Neonatal Intensive Care Unit, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Mechthild Schulze Becking
- Dept. of Pediatric and Neonatal Intensive Care Unit, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Marc-Philipp Hitz
- Insitute for Medical Genetics, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Laura Gieldon
- Insitute for Medical Genetics, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | | | - Brigitte Bison
- Dept. of Neuroradiology, University Hospital of Augsburg , Augsburg , Germany
| | - Florian Hoppe
- Dept. of Otorhinolaryngology-Head and Neck Surgery, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Hermann L Müller
- Dept. of Pediatrics and Pediatric Hematalogy / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
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Mynarek M, Goschzik T, Kool M, von Hoff K, Ottensmeier H, Warmuth-Metz M, Bison B, Sill M, Rushing EJ, Hasselblatt M, Koch A, Schüller U, von Deimling A, Riemenschneider MJ, Dohmen H, Monoranu CM, Sommer C, Staszewski O, Mawrin C, Schittenhelm J, Brück W, Filipski K, Hartmann C, Meinhardt M, Pietschmann K, Haberler C, Slavc I, Gerber NU, Grotzer M, Benesch M, Schlegel PG, Deinlein F, Bode U, von Bueren AO, Friedrich C, Obrecht D, Fleischhack G, Kwiecien R, Faldum A, Kortmann RD, Pietsch T, Pfister S, Rutkowski S. MEDB-04. Young children with metastatic medulloblastoma: frequent requirement for radiotherapy in children with non-WNT/non-SHH medulloblastoma despite highly intensified chemotherapy – Results of the MET-HIT2000-BIS4 trial. Neuro Oncol 2022. [PMCID: PMC9165157 DOI: 10.1093/neuonc/noac079.379] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To assess outcomes and biological parameters of children younger than 4 years with metastatic medulloblastoma treated within the MET-HIT2000-BIS4 trial or outside the protocol. PATIENTS AND METHODS: 48 trial participants received either carboplatin/etoposide (years 2001 to 2005, n=18) or an intensified Head-Start-based induction (years 2006 to 2011, n=30), both groups with intraventricular methotrexate, followed by high-dose chemotherapy (HDCT) and/or craniospinal radiotherapy (CSI). In an extended cohort, data of 58 additional were grouped with trial participant data. RESULTS: Trial participants (n=48): After intensified induction, both response (26/27 vs. 10/17 eligible patients, p=0.003), and progression-free survival (PFS, 5-year-PFS (5y-PFS): 57% vs 28%, p=0.014) was higher after intensified induction. However, CSI- /progression-free survival (CSIfPFS) was low (5-year CSIfPFS 17%). Biological subtype influenced 5y-CSIfPFS with 3% in non-WNT/non-SHH medulloblastoma vs. 58% in SHH-medulloblastoma (p<0.001), independent of induction regimens. Extended cohort (n=48 on trial and n=58 off trial): Non-WNT/non-SHH medulloblastoma (n=74, all treated in analogy to the MET-HIT2000-BIS4 protocol): Most frequent subtypes were II (5y-PFS 0%, 5y-OS 7%, n=21) and IV (5y-PFS 55%, 5y-OS 57%, n=16). 5y-CSIfPFS was only 8% [n=5]. Among patients in CR (n=13) or PR (n=10), who received HDCT but not CSI in primary therapy, only 5 were CSI-free survivors (CR: n=4/PR: n=1; Subtype III: n=1, Subtype IV: n=2, non-WNT/non-SHH by histology: n=2). SHH-medulloblastoma (n=32, treated with MET-HIT2000-BIS4 [n=16] or HIT2000-BIS4/HIT-SKK chemotherapy [with intrventricular methotrexate, without HDCT; n=16]): 5y-PFS (72%) and 5y-CSIfPFS (69%) did not differ according to therapy or SHH-subgroups. Two therapy-related deaths occurred on MET-HIT2000-BIS4 therapy. Relapses were more frequent after HIT-SKK (p=0.083). CONCLUSIONS: Despite maximally intensified chemotherapy, patients with metastatic non-WNT/non-SHH medulloblastoma almost always require craniospinal radiotherapy to survive their disease. In SHH-activated medulloblastoma, HDCT might better control the disease but careful vigilance of toxicity is important.
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Affiliation(s)
- Martin Mynarek
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
- Mildred Scheel Cancer Career Center HaTriCS, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Tobias Goschzik
- Institute of Neuropathology, Brain Tumor Reference Center of the German Society for Neuropathology and Neuroanatomy (DGNN) , Bonn , Germany
| | - Marcel Kool
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ) and Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg , Germany
- Princess Máxima Center for pediatric oncology , Utrecht , Netherlands
| | - Katja von Hoff
- Department of Pediatric Oncology, Charite – Universitätsmedizin Berlin , Berlin , Germany
| | - Holger Ottensmeier
- epartment of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg , Würzburg , Germany
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg , Würzburg , Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital Augsburg , Augsburg , Germany
| | - Martin Sill
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ) , Heidelberg , Germany
- Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg , Germany
| | | | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Muenster , Münster , Germany
| | - Arend Koch
- Department of Neuropathology, Charite – University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf , Hamburg , Germany
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology (B300), German Cancer Research Center (DKFZ) , Heidelberg , Germany
- Department of Neuropathology, Heidelberg University Hospital , Heidelberg , Germany
| | | | - Hildegard Dohmen
- Institute for Neuropathology, University Hospital Gießen and Marburg, Gießen, Germany
| | - Camelia-Maria Monoranu
- Institute of Pathology, Department of Neuropathology, University of Wuerzburg , Würzburg , Germany
- Comprehensive Cancer Center (CCC) Mainfranken , Würzburg , Germany
| | - Clemens Sommer
- nstitute for Neuropathology, University Medical Center of the Johannes Gutenberg University Mainz , Mainz , Germany
| | - Ori Staszewski
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg , Freiburg , Germany
- Berta-Ottenstein-Programme for Advanced Clinician Scientists, Faculty of Medicine, University of Freiburg , Freiburg , Germany
| | - Christian Mawrin
- Institute for Neuropathology, University of Magdeburg , Magdeburg , Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Institute for Pathology and Neuropathology, University Medical Center Tuebingen , Tuebingen , Germany
| | - Wolfgang Brück
- Institute for Neuropathology, University Medical Center Goettingen , Goettingen , Germany
| | - Katharina Filipski
- Institute of Neurology (Edinger Institute), University Hospital, Frankfurt Cancer Institute (FCI) and University Cancer Center (UCT) Frankfurt , Frankfurg , Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz and German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute for Pathology, Hannover Medical School , Hannover , Germany
| | - Matthias Meinhardt
- Institute for Pathology, University Medical Center Carl Gustav Carus, Technical University Dresden , Dresden , Germany
| | - Klaus Pietschmann
- Department for Radiotherapy, Poliklinik Chemnitz , Chemnitz , Germany
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna , Vienna , Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna , Vienna , Austria
| | - Nicolas U Gerber
- Department of Oncology, University Children's Hospital , Zurich , Switzerland
- Children's Research Centre, University Children's Hospital , Zurich , Switzerland
| | - Michael Grotzer
- Department of Oncology, University Children's Hospital , Zurich , Switzerland
- Children's Research Centre, University Children's Hospital , Zurich , Switzerland
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz , Graz , Austria
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg , Wuerzburg , Germany
| | - Frank Deinlein
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg , Wuerburg , Germany
| | - Udo Bode
- Department of Paediatric Haematology/Oncology, Children Medical Hospital, University of Bonn , Bonn , Germany
| | - André O von Bueren
- Department of Pediatrics, Obstetrics and Gynecology, Division of Pediatric Hematology and Oncology, University Hospital of Geneva , Geneva , Switzerland
- Cansearch Research platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva , Geneva , Switzerland
| | - Carsten Friedrich
- Department of General Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital , Oldenburg , Germany
| | - Denise Obrecht
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf , Hamburg , Germany
| | - Gudrun Fleischhack
- Paediatric Haematology and Oncology, Paediatrics III, University Hospital of Essen , Essen , Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Muenster , Muenster , Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster , Muenster , Germany
| | | | - Torsten Pietsch
- Institute of Neuropathology, Brain Tumor Reference Center of the German Society for Neuropathology and Neuroanatomy (DGNN), University of Bonn Medical Center , Bonn , Germany
| | - Stefan Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ) and Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg , Germany
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital , Heidelberg , Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf , Hamburg , Germany
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Boekhoff S, Beckhaus J, Eveslage M, Friedrich C, Müller HL. RARE-05. Legal degree of disability in childhood-craniopharyngioma survivors during long-term follow-up – results of the HIT-ENDO study. Neuro Oncol 2022. [PMCID: PMC9164938 DOI: 10.1093/neuonc/noac079.030] [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
BACKGROUND: Cranioparyngiomas are rare low-grade embryonic malformational tumors of the sellar/parasellar region. The prognosis after diagnosis during childhood and adolescence is influenced by endocrine and hypothalamic long-term sequelae. A legal status of the degree of disability (GdB), according to the German Social Code Book V that is worthy of support, provides financial means for psychosocial rehabilitation and participation of craniopharyngioma survivors. The aim of this study was to determine the association of clinical/psychosocial characteristics and quality of life (QoL) indicators with the resulting GdB. PATIENTS AND METHODS: HIT-Endo is a German registry study on craniopharyngioma patients aged ≤ 18 years at diagnosis and included before the year 2000. In a sample of 108 patients, the degree of disability and the association with endocrine, ophthalmological, neuropsychological and psychosocial parameters was analyzed after a mean follow-up period of 16 years (95% CI: 9.8-36.4). RESULTS: 44 patients (41%) did not receive a GdB, three patients (3%) received a GdB of 30-40, 43 patients (40%) a GdB of 50-90 and 18 patients (17%) the maximum GdB of 100. Higher GdB were associated with lower education, higher body mass index standard deviation and a higher degree of visual impairment and hypothalamic involvement of the craniopharyngeoma. Patients with a GdB of 100 reported loss in physical and cognitive function, as well as fatigue, dyspnea, and pain conditions, and limitations in social and occupational contexts. They further had a lower functional capacity (German daily life ability scale (FMH)) compared to those with a smaller GdB. CONCLUSION: The GdB is associated with psychosocial and physical impairments and reflects the long-term consequences of craniopharyngioma during childhood and adolescence. A low functional capacity (assessed by FMH) may indicate the eligibility for a high GdB in later life of craniopharyngioma survivors.
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Affiliation(s)
- Svenja Boekhoff
- Dep. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Julia Beckhaus
- Dep. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Maria Eveslage
- Institute for Biostatistics and Clinical Research, University of Münster , Münster , Germany
| | - Carsten Friedrich
- Dep. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Hermann L Müller
- Dep. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
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Obrecht D, Bockmayr ML, Bison B, Pfister SM, Sturm D, Sahm F, Jones DTW, Sill M, von Hoff K, Benesch M, Gerber NU, von Bueren A, Friedrich C, Pietsch T, Schüller U, Mynarek M, Rutkowski S. MEDB-37. Chemotherapy response prediction by molecular risk factors in metastatic childhood medulloblastoma. Neuro Oncol 2022. [PMCID: PMC9165010 DOI: 10.1093/neuonc/noac079.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Childhood metastatic medulloblastoma (MB) frequently receive postoperative chemotherapy (CT) before craniospinal irradiation. Some MB show stable (SD) or progressive disease (PD) upon CT. Identification of biomarkers for non-response might allow therapy-modifications. METHODS: Patients registered to the German HIT-MED database (2001–2019) were eligible if they were 4-21 years old at diagnosis of a M2/M3-metastasized MB, received therapy in analogy to the MET-HIT2000-AB4 protocol, had centrally reviewed response assessment after 2 cycles HIT-SKK-CT and DNA-methylation analysis was available. DNA-methylation-based tumor classification and whole chromosomal (WC) losses/gains were derived from DNA-methylation arrays. RESULTS: 51/163 (31.3%) patients (median age: 9.8±4.4 years, median follow-up: 6.2±4.0 years) presented SD/PD during/after HIT-SKK-CT and were classified as non-responder. Response to CT had high predictive value for PFS/OS (5-year PFS responder: 67.9±4.8 %, non-responder: 26.1±6.6%, p<0.01 / 5-year OS responder: 80.0±4.2%, non-responder: 45.9±8.0%, p<0.01). Patients with nonWNT/nonSHH-MB subtype II (response: 7/13), subtype III (response: 6/19) and/or MYC-amplification (n=27, overlap subtype II/III: n=11/8, response: 14/27) were less likely to respond, while all 6 of WNT, 8/9 SHH-TP53-wildtype and 1/1 SHH-TP53-mutant responded (Mann-Whitney-U-test p=0.04). Further, ≥2 WC losses/gains of chromosome 7/8/11 was associated with superior response (n=29/32, others: n=83/131, Mann-Whitney-U-test p<0.01). We identified a very-high-risk-cohort (any two criteria of: <2 WC losses/gains of chromosome 7/8/11, MYC-amplification, MB subtype II, III, V, or VIII, n=94), and a standard-risk-cohort (WNT or any ≥2 WC losses/gains of chromosome 7/8/11, n=37) with 40 vs. 8 % non-response and 44±5/60±5 vs. 79±7/87±6% 5-year PFS/OS (p<0.01/p<0.01), respectively. Non-response in n=32 non-VHR/non-SR-patients was 32% with a 5-years PFS/OS of 60±10/77±8%. CONCLUSION: Molecular information can be helpful to predict response to chemotherapy. Upon validation, this may contribute to improve treatment stratification in metastatic MB.
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Affiliation(s)
- Denise Obrecht
- Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf , Hamburg, Hamburg , Germany
| | - Michael Ludwig Bockmayr
- Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf , Hamburg, Hamburg , Germany
- Research Institute Kinderkrebs-Zentrum Hamburg , Hamburg, Hamburg , Germany
| | - Brigitte Bison
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg , Ausburg , Germany
| | - Stefan M Pfister
- Hopp Children’s Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK) , Heidelberg , Germany
| | - Dominik Sturm
- Hopp Children’s Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
- KiTZ Clinical Trial Unit (ZIPO), Department of Pediatric Hematology and Oncology , Heidelberg , Germany
| | - Felix Sahm
- Hopp Children’s Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
- Department of Neuropathology, University Heidelberg, and, CCU Neuropathology, German Cancer Research Center (DKFZ), and, German Consortium for Translational Cancer Research (DKTK) , Heidelberg , Germany
| | - David T W Jones
- Hopp Children’s Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
- Pediatric Glioma Research Group, German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Martin Sill
- Hopp Children’s Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
- KiTZ Clinical Trial Unit (ZIPO), Department of Pediatric Hematology and Oncology , Heidelberg , Germany
| | - Katja von Hoff
- Department for Pediatric Oncology and Hematology, Chariteé – University Medical Center, Universitätsmedizin Berlin , Berlin , Germany
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz , Graz , Austria
| | - Nicolas U Gerber
- Department of Pediatric Oncology, University Children's Hospital Zürich, Zürich, Switzerland
| | - André von Bueren
- Department of Pediatrics, Obstetrics and Gynecology, Division of Pediatric Hematology and Oncology, University Hospital of Geneva , Geneva , Switzerland
| | - Carsten Friedrich
- Department of General Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital , Oldenburg , Germany
| | - Torsten Pietsch
- Institute of Neuropathology, Brain Tumor Reference Center of the German Society for Neuropathology and Neuroanatomy (DGNN), University of Bonn, DZNE German Center for Neurodegenerative Diseases , Bonn , Germany
| | - Ulrich Schüller
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
- Research Institute Kinderkrebs-Zentrum Hamburg , Hamburg, Hamburg , Germany
| | - Martin Mynarek
- Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf , Hamburg, Hamburg , Germany
- Mildred Scheel Cancer Career Center HaTriCS, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Stefan Rutkowski
- Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf , Hamburg, Hamburg , Germany
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Friedrich C, Boekhoff S, Sowithayasakul P, Eveslage M, Bison B, Timmermann B, Müller HL. RARE-09. Treatment of childhood-onset craniopharyngioma patients using proton beam therapy versus photon-based radiation therapy in the prospective KRANIOPHARYNGEOM 2007 trial. Neuro Oncol 2022. [PMCID: PMC9165167 DOI: 10.1093/neuonc/noac079.034] [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: 11/18/2022] Open
Abstract
BACKGROUND: Proton beam therapy (PBT) compared to photon-based radiotherapy (XRT) offers the benefit to administer lower radiation doses to critical organs thereby possibly minimizing the risk of sequelae in patients with residual craniopharyngiomas (CP) after hypothalamus-sparing surgery. The validation in large CP patient cohorts is still pending. PATIENTS AND METHODS: Of 290 childhood-onset CP patients included 2007-2019 in the prospective multicenter trial KRANIOPHARYNGEOM 2007, 99 (34%) received external RT (65% PBT, 35% XRT). Outcome was compared between the different groups in terms of overall (OS) and event-free survival (EFS), quality of life (QoL using PEDQOL), functional capacity (FMH), and auxological data (BMI and height SDS) one, three and five years after irradiation/CP diagnosis. RESULTS: PBT became the predominant irradiation technique during the study period (used in 23% and 77% of all irradiated patients registered within the first and second half of the enrollment period, respectively). PBT as well as XRT were associated with high (p<0.001) EFS (PBT: 0.917 ± 0.040; XRT: 0.940 ± 0.041) compared to non-RT (EFS: 0.669 ± 0.044). OS was similar in all groups. No differences between PBT, XRT and non-RT CP patients concerning functional capacity and anthropometric parameters (height SDS, BMI SDS) have been obtained. Only in the PEDQOL domain “physical function”, proxy-assessed QoL was lower one year after PBT when compared to XRT treated and non-irradiated CP patients. CONCLUSION: PBT is similar efficient in preventing relapses and recurrences in childhood-onset CP patients. During follow-up, no clinically relevant differences between PBT and XRT in terms of QoL, functional capacity and degree of obesity as a marker of hypothalamic syndrome were detectable. While PBT is increasingly applied, studies on larger CP cohorts with longer follow-up after RT are warranted to analyze, whether it can prevent sequelae such as hypothalamic syndrome and severe obesity compared to XRT.
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Affiliation(s)
- Carsten Friedrich
- Dep. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Svenja Boekhoff
- Dep. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
| | - Panjarat Sowithayasakul
- Dep. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University , Bangkok , Thailand
| | - Maria Eveslage
- Institute for Biostatistics and Clinical Research, University of Münster , Münster , Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital Augsburg , Augsburg , Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ) and German Cancer Consortium (DKTK) , Germany, Essen , Germany
| | - Hermann L Müller
- Dep. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg, Oldenburg , Germany
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21
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Tonn S, Obrecht D, Sill M, Spohn M, Milde T, Pietsch T, Bison B, Juhnke BO, Struve N, Friedrich C, von Bueren AO, Gerber NU, Benesch M, Jäger N, Kool M, Korshunov A, Schüller U, Pfister SM, Rutkowski S, Mynarek M. MEDB-41. Identifying a subgroup of patients with early childhood sonic hedgehog-activated medulloblastoma with unfavorable prognosis after treatment with radiation-sparing regimens including intraventricular methotrexate. Neuro Oncol 2022. [PMCID: PMC9165318 DOI: 10.1093/neuonc/noac079.415] [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: 11/20/2022] Open
Abstract
PURPOSE/METHODS: Clinical and molecular risk factors in 142 patients <5 years with desmoplastic medulloblastoma (DMB) or medulloblastoma with extensive nodularity (MBEN) were investigated. Patients were diagnosed between 1992 and 2020 and treated with radiation-sparing approaches, 131 with intraventricular methotrexate. 14 patients with metastatic disease received high-dose chemotherapy. DNA methylation profiles of 77 sonic hedgehog (SHH)-activated medulloblastoma were reclassified according to the Heidelberg Brain Tumor Classifier Version 12.3. RESULTS: While metastatic disease or incomplete resection did not impact progression-free survival (PFS) and overall survival (OS), patients with MBEN had superior outcomes to DMB (5-year PFS 93% vs 71%, p=0.004; 5-year OS 100% vs 90%, p=0.026). Older patients had less favorable PFS (5-year PFS [>3 years] 47% vs 85% [<1 year] vs 84% [1-3 years], p<0.001). No TP53 mutations were detected (n=47). DNA methylation classification identified three subgroups: SHH-1v12.3 (n=39), SHH-2v12.3 (n=19), and SHH-3v12.3 (n=19), with distinct cytogenetic profiles (chromosome 2 gains in SHH-1v12.3, very few alterations in SHH-2v12.3, and chromosome 9q losses in SHH-3v12.3), age profiles (median age [years] SHH-1v12.3: 1.7, SHH-2v12.3: 0.9, SHH-3v12.3: 3.0, p<0.001), and histological distribution (SHH-2v12.3: 74% MBEN, SHH-1v12.3/SHH-3v12.3: 77%/79% DMB, p<0.001). PFS was more unfavorable in patients with SHH-3v12.3-medulloblastoma (5-year PFS 53% vs 86% [SHH-1v12.3] vs 95% [SHH-2v12.3], p=0.002), which remained the only risk factor on multivariable Cox regression for PFS. OS was comparable (5-year OS 94% [SHH-3v12.3] vs 97% [SHH-1v12.3] vs 100% [SHH-2v12.3], p=0.6). 8/9 patients with SHH-3v12.3-medulloblastoma received radiotherapy at relapse (6 craniospinal, 2 local [1 Gorlin syndrome, 1 BRCA2 germline mutation], 1 no radiotherapy [Gorlin syndrome]). CONCLUSION: We identify patients with an increased risk of relapse when treated with radiation-sparing approaches among children with early childhood SHH-medulloblastoma. If these tumors differ from SHH-3-medulloblastoma typically described in older children remains to be verified. Treatment recommendations need to consider cancer predisposition syndromes.
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Affiliation(s)
- Svenja Tonn
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Denise Obrecht
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Martin Sill
- Hopp Children's Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) , Heidelberg , Germany
| | - Michael Spohn
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
- Research Institute Children’s Cancer Center Hamburg , Hamburg , Germany
| | - Till Milde
- Hopp Children's Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital , Heidelberg , Germany
| | - Torsten Pietsch
- Institute of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Center , Bonn , Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital Wuerzburg , Wuerzburg , Germany
- Neuroradiological Reference Center for the pediatric brain tumor (HIT) studies of the German Society of Pediatric Oncology and Hematology, University Hospital Wuerzburg (until2020), University Augsburg, Faculty of Medicine (since2021) , Augsburg , Germany
| | - Björn-Ole Juhnke
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Nina Struve
- Department of Radiotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
- Mildred Scheel Cancer Career Center HaTriCS, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University , Oldenburg , Germany
| | - André O von Bueren
- Division of Pediatric Oncology and Hematology, Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva , Geneva , Switzerland
- CANSEARCH research platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva , Geneva , Switzerland
| | - Nicolas U Gerber
- Department of Oncology, University Children's Hospital , Zurich , Switzerland
| | - Martin Benesch
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz , Graz , Austria
| | - Natalie Jäger
- Hopp Children's Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) , Heidelberg , Germany
| | - Marcel Kool
- Hopp Children's Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) , Heidelberg , Germany
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology (B300), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK) , Heidelberg , Germany
- Department of Neuropathology, Heidelberg University Hospital , Heidelberg , Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
- Institute for Neuropathology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital , Heidelberg , Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
- Mildred Scheel Cancer Career Center HaTriCS, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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22
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Sowithayasakul P, Boekhoff S, Friedrich C, Müller HL. RARE-03. Vision-related quality of life in patients with childhood-onset craniopharyngioma – results of KRANIOPHARYNGEOM 2000 / 2007. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Quality of life (QoL) has become a critical component of therapeutic outcomes in the survivors of childhood-onset adamantinomatous craniopharyngioma (CP) patients. Visual deficiency adversely affects daily functioning and QoL. This study aimed to report the vision-related QoL and associated factors in CP patients. PATIENTS AND METHODS: 120 CP patients recruited between 2001 and 2019 in KRANIOPHARYNGEOM 2000/2007 were included in this study. Mean age at CP diagnosis was 10 years (range: 1.3-16.8 years); age at study was 18 years (range: 6-33 years). The primary outcome measures were QoL assessed by PEDQOL, functional capacity measured by Fertigkeitenskala Münster-Heidelberg ability scale and risk factors associated with decreased QoL during 3 years follow-up in CP patients with and without visual impairment (VI). RESULTS: The most common presenting symptoms were headache (42%), VI (20%), and growth retardation (12%). After diagnosis, VI defined as visual acuity less than 20/40, was found in 87 (70%) patients. Ophthalmologic examination and PEDQOL score were evaluated at three months, one year, and 3 years after CP diagnosis. A difference in the parental assessment of CP patient social functioning within the family was found between patients with and without VI in the first year (48 vs. 39, p=0.017) and third year (43 vs. 37, p=0.011). For the PEDQOL domain autonomy, a difference in self- (51 vs. 45, p=0.029) and parental (47 vs. 42, p=0.048) assessment was observed 3 years after diagnosis. In terms of risk factors, tumor volume more than 21 mm3, incomplete tumor resection and optic atrophy at initial presentation were associated with VI during follow-up. CONCLUSIONS: VI has an impact on QoL after CP. Accordingly, early detection of VI, together with the assessment of the patient’s QoL and the provision of adequate support during follow-up plays an important role in minimizing adverse late effects after CP.
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Affiliation(s)
- Panjarat Sowithayasakul
- Dept. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg , Oldenburg , Germany
- Dept. of Pediatrics, Facult of Medicine, Srinakharinwirot University , Bangkok , Thailand
| | - Svenja Boekhoff
- Dept. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg , Oldenburg , Germany
| | - Carsten Friedrich
- Dept. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg , Oldenburg , Germany
| | - Hermann L Müller
- Dept. of Pediatrics and Pediatric Hematology / Oncology, University Children's Hospital, Klinikum Oldenburg , Oldenburg , Germany
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23
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Kaplan G, Berg M, Friedrich C, Schimanski CC, Heyne von Haußen R, Bergmann F. Erratum: Endosonographisch gesteuerte Feinnadelbiopsie vs. Feinnadelaspiration von Pankreaskarzinomen. Z Gastroenterol 2022. [DOI: 10.1055/a-0658-7795] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- G Kaplan
- Klinikum Darmstadt GmbH, Medizinische Klinik II, Darmstadt, Deutschland
| | - M Berg
- Klinikum Darmstadt GmbH, Medizinische Klinik II, Darmstadt, Deutschland
| | - C Friedrich
- Klinikum Darmstadt GmbH, Medizinische Klinik II, Darmstadt, Deutschland
| | - CC Schimanski
- Klinikum Darmstadt GmbH, Medizinische Klinik II, Darmstadt, Deutschland
| | - R Heyne von Haußen
- Klinikum Darmstadt GmbH, MVZ Pathologie des Klinikum Darmstadt GmbH, Darmstadt, Deutschland
| | - F Bergmann
- Klinikum Darmstadt GmbH, MVZ Pathologie des Klinikum Darmstadt GmbH, Darmstadt, Deutschland
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24
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Obrecht D, Mynarek M, Hagel C, Kwiecien R, Spohn M, Bockmayr M, Bison B, Pfister SM, Jones DTW, Sturm D, von Deimling A, Sahm F, von Hoff K, Juhnke BO, Benesch M, Gerber NU, Friedrich C, von Bueren AO, Kortmann RD, Schwarz R, Pietsch T, Fleischhack G, Schüller U, Rutkowski S. Clinical and molecular characterization of isolated M1 disease in pediatric medulloblastoma: experience from the German HIT-MED studies. J Neurooncol 2022; 157:37-48. [PMID: 35190934 PMCID: PMC8938370 DOI: 10.1007/s11060-021-03913-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/23/2021] [Indexed: 12/03/2022]
Abstract
Purpose To evaluate the clinical impact of isolated spread of medulloblastoma cells into cerebrospinal fluid without additional macroscopic metastases (M1-only). Methods The HIT-MED database was searched for pediatric patients with M1-only medulloblastoma diagnosed from 2000 to 2019. Corresponding clinical and molecular data was evaluated. Treatment was stratified by age and changed over time for older patients. Results 70 patients with centrally reviewed M1-only disease were identified. Clinical data was available for all and molecular data for 45/70 cases. 91% were non-WNT/non-SHH medulloblastoma (Grp3/4). 5-year PFS for 52 patients ≥ 4 years was 59.4 (± 7.1) %, receiving either upfront craniospinal irradiation (CSI) or SKK-sandwich chemotherapy (CT). Outcomes did not differ between these strategies (5-year PFS: CSI 61.7 ± 9.9%, SKK-CT 56.7 ± 6.1%). For patients < 4 years (n = 18), 5-year PFS was 50.0 (± 13.2) %. M1-persistence occurred exclusively using postoperative CT and was a strong negative predictive factor (pPFS/OS < 0.01). Patients with additional clinical or molecular high-risk (HR) characteristics had worse outcomes (5-year PFS 42.7 ± 10.6% vs. 64.0 ± 7.0%, p = 0.03). In n = 22 patients ≥ 4 years with full molecular information and without additional HR characteristics, risk classification by molecular subtyping had an effect on 5-year PFS (HR 16.7 ± 15.2%, SR 77.8 ± 13.9%; p = 0.01). Conclusions Our results confirm that M1-only is a high-risk condition, and further underline the importance of CSF staging. Specific risk stratification of affected patients needs attention in future discussions for trials and treatment recommendations. Future patients without contraindications may benefit from upfront CSI by sparing risks related to higher cumulative CT applied in sandwich regimen. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03913-5.
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Affiliation(s)
- Denise Obrecht
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Mynarek
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Münster, Munster, Germany
| | - Michael Spohn
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
| | - Michael Bockmayr
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Research Institute Children's Cancer Center Hamburg, Hamburg, Germany.,Institute of Pathology, Charité University Medicine, Berlin, Germany
| | - Brigitte Bison
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.,KiTZ Clinical Trial Unit (ZIPO), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dominik Sturm
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.,KiTZ Clinical Trial Unit (ZIPO), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University of Heidelberg, Heidelberg, Germany.,CCU Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.,Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Sahm
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Department of Neuropathology, University of Heidelberg, Heidelberg, Germany.,CCU Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.,Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katja von Hoff
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany
| | - B-Ole Juhnke
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Nicolas U Gerber
- Department of Oncology, University Children's Hospital, Zurich, Switzerland
| | - Carsten Friedrich
- Department of Pediatric Oncology and Hematology, University Children's Hospital Oldenburg, Oldenburg, Germany
| | - André O von Bueren
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Obstetrics and Gynecology, University Hospital of Geneva, Geneva, Switzerland.,CANSEARCH Research Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Rudolf Schwarz
- Department for Radiotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, Brain Tumor Reference Center of the German Society for Neuropathology and Neuroanatomy (DGNN), University of Bonn, DZNE German Center for Neurodegenerative Diseases, Bonn, Germany
| | | | - Ulrich Schüller
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
| | - Stefan Rutkowski
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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25
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Hagel C, Sloman V, Mynarek M, Petrasch K, Obrecht D, Kühl J, Deinlein F, Schmid R, von Bueren AO, Friedrich C, Juhnke BO, Gerber NU, Kwiecien R, Girschick H, Höller A, Zapf A, von Hoff K, Rutkowski S. Refining M1 stage in medulloblastoma: criteria for cerebrospinal fluid cytology and implications for improved risk stratification from the HIT-2000 trial. Eur J Cancer 2022; 164:30-38. [PMID: 35151105 DOI: 10.1016/j.ejca.2021.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Medulloblastoma is the most common malignant paediatric brain tumour, and cerebrospinal fluid (CSF) dissemination (M1 stage) is a high-risk prognostic factor. Criteria for CSF evaluation and for differentiating M0 from M1 stage are not clearly defined, and the prognostic significance of M1 stage in this context is unknown. PATIENTS AND METHODS CSF investigations from 405 patients with medulloblastoma of the prospective multicenter trial HIT-2000 (HIirnTumor-2000) were reviewed. Data from 213 patients aged ≥4 years were related to 5-year progression-free (5y-PFS) and overall survival. RESULTS Patients with cytological tumour dissemination only (M1 stage only) aged ≥4 years (n = 18) and patients with radiologically detected metastases (M2/3, n = 85) showed a worse 5y-PFS than M0 patients (n = 110) without signs of metastatic disease (5y-PFS 61.1% and 59.6% vs 80.7%; p < 0.02 and p < 0.01, log rank). Patients with positive samples drawn early after surgery who turned negative within 14 days postoperatively (n = 9) and patients with atypical cells (n = 6) showed a 5y-PFS similar to M0 patients. No tumour cells were detected in samples containing <10 nucleated cells. Analysis of cytological criteria showed a better predictive value for tumour cell clusters than ≥2 individual tumour cells. CONCLUSION Based on our results, we suggest that CSF medulloblastoma staging should be performed 14 days postoperatively by lumbar puncture, and specimens should contain at least 10 nucleated cells. Cytological tumour dissemination alone (M1 stage only) appears a high-risk prognostic factor associated with an outcome comparable to M2/M3 stage. Tumour cell clusters seem to have a greater impact on prognosis than single tumour cells. This should be validated further.
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Affiliation(s)
- Christian Hagel
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
| | - Veronika Sloman
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Petrasch
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Denise Obrecht
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Kühl
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg, Germany
| | - Frank Deinlein
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg, Germany
| | - Renate Schmid
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg, Germany
| | - André O von Bueren
- Department of Pediatrics, Obstetrics and Gynecology, Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Carsten Friedrich
- Department of General Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - B Ole Juhnke
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolas U Gerber
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Robert Kwiecien
- Institut für Biometrie und Klinische Forschung, Universitätsklinikum Münster, Münster, Germany
| | - Hermann Girschick
- Kinder- und Jugendmedizin, Vivantes-Klinikum, Berlin Friedrichshain, Berlin, Germany
| | - Alexandra Höller
- Institute of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany; Department of Pediatric Oncology/Hematology, Charité-University Medicine Berlin, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
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26
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Oud MS, Smits RM, Smith HE, Mastrorosa FK, Holt GS, Houston BJ, de Vries PF, Alobaidi BKS, Batty LE, Ismail H, Greenwood J, Sheth H, Mikulasova A, Astuti GDN, Gilissen C, McEleny K, Turner H, Coxhead J, Cockell S, Braat DDM, Fleischer K, D’Hauwers KWM, Schaafsma E, Nagirnaja L, Conrad DF, Friedrich C, Kliesch S, Aston KI, Riera-Escamilla A, Krausz C, Gonzaga-Jauregui C, Santibanez-Koref M, Elliott DJ, Vissers LELM, Tüttelmann F, O’Bryan MK, Ramos L, Xavier MJ, van der Heijden GW, Veltman JA. A de novo paradigm for male infertility. Nat Commun 2022; 13:154. [PMID: 35013161 PMCID: PMC8748898 DOI: 10.1038/s41467-021-27132-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/02/2021] [Indexed: 12/29/2022] Open
Abstract
De novo mutations are known to play a prominent role in sporadic disorders with reduced fitness. We hypothesize that de novo mutations play an important role in severe male infertility and explain a portion of the genetic causes of this understudied disorder. To test this hypothesis, we utilize trio-based exome sequencing in a cohort of 185 infertile males and their unaffected parents. Following a systematic analysis, 29 of 145 rare (MAF < 0.1%) protein-altering de novo mutations are classified as possibly causative of the male infertility phenotype. We observed a significant enrichment of loss-of-function de novo mutations in loss-of-function-intolerant genes (p-value = 1.00 × 10-5) in infertile men compared to controls. Additionally, we detected a significant increase in predicted pathogenic de novo missense mutations affecting missense-intolerant genes (p-value = 5.01 × 10-4) in contrast to predicted benign de novo mutations. One gene we identify, RBM5, is an essential regulator of male germ cell pre-mRNA splicing and has been previously implicated in male infertility in mice. In a follow-up study, 6 rare pathogenic missense mutations affecting this gene are observed in a cohort of 2,506 infertile patients, whilst we find no such mutations in a cohort of 5,784 fertile men (p-value = 0.03). Our results provide evidence for the role of de novo mutations in severe male infertility and point to new candidate genes affecting fertility.
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Affiliation(s)
- M. S. Oud
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - R. M. Smits
- grid.10417.330000 0004 0444 9382Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - H. E. Smith
- grid.1006.70000 0001 0462 7212Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - F. K. Mastrorosa
- grid.1006.70000 0001 0462 7212Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - G. S. Holt
- grid.1006.70000 0001 0462 7212Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - B. J. Houston
- grid.1008.90000 0001 2179 088XSchool of BioSciences, Faculty of Science, The University of Melbourne, Parkville, VIC Australia
| | - P. F. de Vries
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - B. K. S. Alobaidi
- grid.1006.70000 0001 0462 7212Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - L. E. Batty
- grid.1006.70000 0001 0462 7212Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - H. Ismail
- grid.1006.70000 0001 0462 7212Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - J. Greenwood
- grid.420004.20000 0004 0444 2244Department of Genetic Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - H. Sheth
- Foundation for Research in Genetics and Endocrinology, Institute of Human Genetics, Ahmedabad, India
| | - A. Mikulasova
- grid.1006.70000 0001 0462 7212Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - G. D. N. Astuti
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands ,grid.412032.60000 0001 0744 0787Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - C. Gilissen
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | - K. McEleny
- grid.420004.20000 0004 0444 2244Newcastle Fertility Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - H. Turner
- grid.420004.20000 0004 0444 2244Department of Cellular Pathology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J. Coxhead
- grid.1006.70000 0001 0462 7212Genomics Core Facility, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - S. Cockell
- Bioinformatics Support Unit, Faculty of Medical Sciences New, castle University, Newcastle upon Tyne, UK
| | - D. D. M. Braat
- grid.10417.330000 0004 0444 9382Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - K. Fleischer
- grid.10417.330000 0004 0444 9382Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - K. W. M. D’Hauwers
- grid.10417.330000 0004 0444 9382Department of Urology, Radboudumc, Nijmegen, The Netherlands
| | - E. Schaafsma
- grid.10417.330000 0004 0444 9382Department of Pathology, Radboudumc, Nijmegen, The Netherlands
| | | | - L. Nagirnaja
- grid.5288.70000 0000 9758 5690Division of Genetics, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR USA
| | - D. F. Conrad
- grid.5288.70000 0000 9758 5690Division of Genetics, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR USA
| | - C. Friedrich
- grid.5949.10000 0001 2172 9288Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - S. Kliesch
- grid.16149.3b0000 0004 0551 4246Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University Hospital Münster, Münster, Germany
| | - K. I. Aston
- grid.223827.e0000 0001 2193 0096Department of Surgery, Division of Urology, University of Utah School of Medicine, Salt Lake City, UT USA
| | - A. Riera-Escamilla
- grid.418813.70000 0004 1767 1951Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Catalonia Spain
| | - C. Krausz
- grid.8404.80000 0004 1757 2304Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - C. Gonzaga-Jauregui
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Tarrytown, NY USA
| | - M. Santibanez-Koref
- grid.1006.70000 0001 0462 7212Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - D. J. Elliott
- grid.1006.70000 0001 0462 7212Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - L. E. L. M. Vissers
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - F. Tüttelmann
- grid.5949.10000 0001 2172 9288Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - M. K. O’Bryan
- grid.1008.90000 0001 2179 088XSchool of BioSciences, Faculty of Science, The University of Melbourne, Parkville, VIC Australia
| | - L. Ramos
- grid.10417.330000 0004 0444 9382Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - M. J. Xavier
- grid.1006.70000 0001 0462 7212Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - G. W. van der Heijden
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - J. A. Veltman
- grid.1006.70000 0001 0462 7212Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Wyrwoll MJ, van Walree ES, Hamer G, Rotte N, Motazacker MM, Meijers-Heijboer H, Alders M, Meißner A, Kaminsky E, Wöste M, Krallmann C, Kliesch S, Hunt TJ, Clark AT, Silber S, Stallmeyer B, Friedrich C, van Pelt AMM, Mathijssen IB, Tüttelmann F. Bi-allelic variants in DNA mismatch repair proteins MutS Homolog MSH4 and MSH5 cause infertility in both sexes. Hum Reprod 2021; 37:178-189. [PMID: 34755185 DOI: 10.1093/humrep/deab230] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/27/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Do bi-allelic variants in the genes encoding the MSH4/MSH5 heterodimer cause male infertility? SUMMARY ANSWER We detected biallelic, (likely) pathogenic variants in MSH5 (4 men) and MSH4 (3 men) in six azoospermic men, demonstrating that genetic variants in these genes are a relevant cause of male infertility. WHAT IS KNOWN ALREADY MSH4 and MSH5 form a heterodimer, which is required for prophase of meiosis I. One variant in MSH5 and two variants in MSH4 have been described as causal for premature ovarian insufficiency (POI) in a total of five women, resulting in infertility. Recently, pathogenic variants in MSH4 have been reported in infertile men. So far, no pathogenic variants in MSH5 had been described in males. STUDY DESIGN, SIZE, DURATION We utilized exome data from 1305 men included in the Male Reproductive Genomics (MERGE) study, including 90 males with meiotic arrest (MeiA). Independently, exome sequencing was performed in a man with MeiA from a large consanguineous family. PARTICIPANTS/MATERIALS, SETTING, METHODS Assuming an autosomal-recessive mode of inheritance, we screened the exome data for rare, biallelic coding variants in MSH4 and MSH5. If possible, segregation analysis in the patients' families was performed. The functional consequences of identified loss-of-function (LoF) variants in MSH5 were studied using heterologous expression of the MSH5 protein in HEK293T cells. The point of arrest during meiosis was determined by γH2AX staining. MAIN RESULTS AND THE ROLE OF CHANCE We report for the first time (likely) pathogenic, homozygous variants in MSH5 causing infertility in 2 out of 90 men with MeiA and overall in 4 out of 902 azoospermic men. Additionally, we detected biallelic variants in MSH4 in two men with MeiA and in the sister of one proband with POI. γH2AX staining revealed an arrest in early prophase of meiosis I in individuals with pathogenic MSH4 or MSH5 variants. Heterologous in vitro expression of the detected LoF variants in MSH5 showed that the variant p.(Ala620GlnTer9) resulted in MSH5 protein truncation and the variant p.(Ser26GlnfsTer42) resulted in a complete loss of MSH5. LARGE SCALE DATA All variants have been submitted to ClinVar (SCV001468891-SCV001468896 and SCV001591030) and can also be accessed in the Male Fertility Gene Atlas (MFGA). LIMITATIONS, REASONS FOR CAUTION By selecting for variants in MSH4 and MSH5, we were able to determine the cause of infertility in six men and one woman, leaving most of the examined individuals without a causal diagnosis. WIDER IMPLICATIONS OF THE FINDINGS Our findings have diagnostic value by increasing the number of genes associated with non-obstructive azoospermia with high clinical validity. The analysis of such genes has prognostic consequences for assessing whether men with azoospermia would benefit from a testicular biopsy. We also provide further evidence that MeiA in men and POI in women share the same genetic causes. STUDY FUNDING/COMPETING INTEREST(S) This study was carried out within the frame of the German Research Foundation sponsored Clinical Research Unit 'Male Germ Cells: from Genes to Function' (DFG, CRU326), and supported by institutional funding of the Research Institute Amsterdam Reproduction and Development and funds from the LucaBella Foundation. The authors declare no conflict of interest.
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Affiliation(s)
- M J Wyrwoll
- Institute of Reproductive Genetics, University of Münster, Münster, Germany.,Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - E S van Walree
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - G Hamer
- Reproductive Biology Laboratory, Center for Reproductive Medicine, Research Institute Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - N Rotte
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - M M Motazacker
- Laboratory of Genome Diagnostics, Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H Meijers-Heijboer
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M Alders
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Meißner
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E Kaminsky
- Praxis für Humangenetik, Hamburg, Germany
| | - M Wöste
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - C Krallmann
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - S Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - T J Hunt
- Department of Molecular, Cell and Developmental Biology, Los Angeles, CA, USA
| | - A T Clark
- Department of Molecular, Cell and Developmental Biology, Los Angeles, CA, USA
| | - S Silber
- Infertility Center of St Louis, St Luke's Hospital, St Louis, MO, USA
| | - B Stallmeyer
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - C Friedrich
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - A M M van Pelt
- Reproductive Biology Laboratory, Center for Reproductive Medicine, Research Institute Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - I B Mathijssen
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
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28
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Polidori MC, Friedrich C. [79/f-Fall in the bathroom without serious sequelae : Preparation for the medical specialist examination: part 90]. Internist (Berl) 2021; 62:580-584. [PMID: 34643750 DOI: 10.1007/s00108-021-01125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Affiliation(s)
- M C Polidori
- Innere Medizin II - Nephrologie, Rheumatologie, Diabetologie und Allgemeine Innere Medizin, Klinische Altersforschung, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - C Friedrich
- Klinik für Geriatrie, Klinikum Lippe - Universitätsklinikum OWL, Rintelner Straße 85, 32657, Lemgo, Deutschland
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29
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Boekhoff S, Bison B, Genzel D, Eveslage M, Otte A, Friedrich C, Flitsch J, Müller HL. Cerebral Infarction in Childhood-Onset Craniopharyngioma Patients: Results of KRANIOPHARYNGEOM 2007. Front Oncol 2021; 11:698150. [PMID: 34336685 PMCID: PMC8317984 DOI: 10.3389/fonc.2021.698150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cerebral infarction (CI) is a known vascular complication following treatment of suprasellar tumors. Risk factors for CI, incidence rate, and long-term prognosis are unknown for patients with childhood-onset craniopharyngioma (CP). Methods MRI of 244 CP patients, recruited between 2007 and 2019 in KRANIOPHARYNGEOM 2007, were reviewed for CI. Risk factors for CI and outcome after CI were analyzed. Results Twenty-eight of 244 patients (11%) presented with CI based on reference assessment of MRI. One CI occurred before initial surgery and one case of CI occurred after release of intracystic pressure by a cyst catheter. 26 of 28 CI were detected after surgical tumor resection at a median postoperative interval of one day (range: 0.5-53 days). Vascular lesions during surgical procedures were documented in 7 cases with CI. No relevant differences with regard to surgical approaches were found. In all 12 irradiated patients, CI occurred before irradiation. Multivariable analyses showed that hydrocephalus and gross-total resection at the time of primary diagnosis/surgery both were risk factors for CI. After CI, quality of life (PEDQOL) and functional capacity (FMH) were impaired. Conclusions CI occurs in 11% of surgically-treated CP cases. Degree of resection and increased intracranial pressure are risk factors, which should be considered in the planning of surgical procedures for prevention of CI.
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Affiliation(s)
- Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Daniela Genzel
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Anna Otte
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Jörg Flitsch
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany
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30
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Boekhoff S, Bison B, Genzel D, Eveslage M, Otte A, Friedrich C, Flitsch J, Muller HL. Cerebral Infarction in Childhood-Onset Craniopharyngioma Patients - Results of KRANIOPHARYNGEOM 2007. J Endocr Soc 2021. [PMCID: PMC8090724 DOI: 10.1210/jendso/bvab048.1302] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: Cerebral infarction (CI) represents a vascular complication following treatment of suprasellar tumors. Risk factors for CI, incidence rate, and long-term prognosis are unknown for patients with childhood-onset craniopharyngioma (CP). Methods: MRI of 242 CP patients, recruited 2007-2019 in KRANIOPHARYNGEOM 2007, were reviewed for CI. Risk factors for CI and outcome after CI were analyzed. Results: Twenty-eight of 242 patients (11%) presented with CI based on reference assessment of MRI. One CI occurred before initial surgery and one case of CI after release of pressure via intracystic catheter. 26 of 28 CI were detected after CP resecting surgical procedures at a median postoperative interval of one day (range: 0.5-53 days). Surgical intraoperative vascular lesions were documented in 7 cases with CI. There was a trend (p=0.069) towards higher initial presurgical tumor volume in CI patients (21.7 cm3, range: 0.01-187.6 cm3) compared with non-CI patients (15.5 cm3, range: 0.01-286.3 cm3). The CI rate was lower in cases operated via transsphenoidal approach (4%) when compared with transcranial approach (13%). CP patient load of neurosurgical centers as a potential measure of surgical expertise was not associated with CI. In 12 irradiated patients, CI occurred before irradiation in all cases. Multivariate analyses showed that hydrocephalus and gross-total resection (GTR) at the time of primary diagnosis/surgery were independent risk factors for CI. Two-years progression-free survival rate was lower (p=0.023) after CI (0.310±0.095) when compared with the subgroup of patients without CI (0.604±0.034). After CI, quality of life (PEDQOL) and functional capacity (FMH) were impaired when compared with patients without CI. Conclusions: CI occurs in about 11% of CP cases mainly after surgery. Degree of resection and increased intracranial pressure are risk factors, which should be considered in the planning of surgical procedures for prevention of CI.
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Affiliation(s)
- Svenja Boekhoff
- University Children’s Hospital, Klinikum Oldenburg AoR, Oldenburg, Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital Würzburg, Würuburg, Germany
| | - Daniela Genzel
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Anna Otte
- University Children’s Hospital, Klinikum Oldenburg AoR, Oldenburg, Germany
| | - Carsten Friedrich
- University Children’s Hospital, Klinikum Oldenburg AoR, Oldenburg, Germany
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31
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Juhnke BO, Gessi M, Gerber NU, Friedrich C, Mynarek M, von Bueren AO, Haberler C, Schüller U, Kortmann RD, Timmermann B, Bison B, Warmuth-Metz M, Kwiecien R, Pfister SM, Spix C, Pietsch T, Kool M, Rutkowski S, von Hoff K. Treatment of Embryonal Tumours with Multilayered Rosettes with Carboplatin/Etoposide Induction and High-dose Chemotherapy within the Prospective P-HIT Trial. Neuro Oncol 2021; 24:127-137. [PMID: 33908610 DOI: 10.1093/neuonc/noab100] [Citation(s) in RCA: 2] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Embryonal tumours with multilayered rosettes (ETMR) are highly aggressive tumours occurring in early childhood. Published clinical data refer to retrospective, heterogeneously treated cohorts. Here, we describe the outcome of patients treated according to the prospective P-HIT trial and subsequent HIT2000-interim-registry. PATIENTS AND METHODS Age-stratified treatment included carboplatin/etoposide-induction, tandem-high-dose chemotherapy ("CARBO/ETO+HDCT") and response-stratified radiotherapy. Patients with centrally reviewed neuropathological and molecularly confirmed diagnosis of ETMR recruited within the P-HIT trial (2001-2011; n=19), the HIT2000-interim-registry (2012-2014; n=12) and earlier HIT-trials (n=4) were selected for analysis. RESULTS Age-adjusted incidence rate was 1.35 per 1 million children (aged 1-4 years) in the years 2012-2014. Median age at diagnosis for 35 patients was 2.9 years. Metastases at diagnosis were detected in 9 patients. One patient died due to postoperative complications. For 30 patients with non-brainstem tumour location, 5-year progression-free (PFS) and overall survival (OS) were 35% and 47% after treatment with CARBO/ETO+HDCT (n=17), compared to 0% and 8% with other treatments (n=13, p[OS]=0.011). All 4 patients with brainstem tumour died within 10 months after diagnosis. By multivariable analysis, supratentorial location: (HR[PFS]:0.07 [95%CI:0.01-0.38], p=0.003), localised disease (M0): (HR[OS] M0, no residual tumor:0.30 [95%CI:0.009-1.09], p=0.068; M0, residual tumor:0.18 [95%CI: 0.04-0.76], p=0.020) and CARBO/ETO+HDCT treatment (HR[OS]:0.16 [95%CI:0.05-054], p=0.003) were identified as independent prognostic factors. Of 9 survivors, 6 were treated with radiotherapy (craniospinal 4; local 2). CONCLUSIONS Our data indicate improved survival with intensified chemotherapy (CARBO/ETO+HDCT). However, despite intensive treatment, the outcome was poor. Thus, innovative therapies need to be evaluated urgently in an upfront setting.
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Affiliation(s)
- B-Ole Juhnke
- HIT-MED Study Centre, Clinic for Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Marco Gessi
- Neuropathology Unit, Division of Pathology, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Catholic University Rome, Italy
| | - Nicolas U Gerber
- Department of Oncology, University Children's Hospital Zürich, Switzerland
| | - Carsten Friedrich
- Department of Paediatrics and Paediatric Haematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Germany
| | - Martin Mynarek
- HIT-MED Study Centre, Clinic for Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Germany
| | - André O von Bueren
- Department of Paediatrics, Obstetrics and Gynaecology, Division of Paediatric Haematology and Oncology, University Hospital of Geneva, Switzerland
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - Ulrich Schüller
- Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, and Research Institute Children's Cancer Center Hamburg, Germany
| | - Rolf-Dieter Kortmann
- HIT Radiotherapy Reference Centre, Clinic for Radiotherapy, Leipzig University Medicine, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ) and German Cancer Consortium (DKTK), Germany
| | - Brigitte Bison
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Germany
| | - Monika Warmuth-Metz
- HIT Neuroradiology Reference Centre, Institute for Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, Faculty of Medicine, University of Münster, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center (KITZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Torsten Pietsch
- DGNN Brain Tumour Reference Centre, Institute of Neuropathology, University Hospital Bonn, Germany
| | - Marcel Kool
- Hopp Children's Cancer Center (KITZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Stefan Rutkowski
- HIT-MED Study Centre, Clinic for Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Katja von Hoff
- Division of Oncology and Haematology, Department of Paediatrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
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32
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Goschzik T, Zur Muehlen A, Doerner E, Waha A, Friedrich C, Hau P, Pietsch T. Medulloblastoma in Adults: Cytogenetic Phenotypes Identify Prognostic Subgroups. J Neuropathol Exp Neurol 2021; 80:419-430. [PMID: 33870422 DOI: 10.1093/jnen/nlab020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Adult medulloblastomas (MB) are rare. We investigated the genetic landscape and prognostic impact of genetic aberrations in a cohort of 117 adult medulloblastomas. Histological features and pathway activation were evaluated at the protein level; 14.5% showed wingless-type activation, 63.3% SHH activation, and 22.2% were classified as non-WNT/non-SHH-MB. Genome-wide copy number analysis was performed by molecular inversion probe array technology. MB-related genes were sequenced in WNT- and SHH-activated MBs. 79.7% of SHH-MBs showed desmoplastic/nodular histology; all other MBs had classic histology. WNT-MBs carried oncogenic CTNNB1 mutations in 88.2% and had monosomy 6 in 52.9%. In SHH-MBs, TERT promoter mutations occurred in 97%, mutations in PTCH1 in 38.2%, SMO in 15.5%, SUFU in 7.4%, and TP53-mutations in 4.1%. In all, 84.6% of non-WNT/non-SHH-MBs had an isochromosome 17q. A whole chromosomal aberration (WCA) signature was present in 45.1% of SHH-TP53-wild type (wt)-MBs and 65.4% of non-WNT/non-SHH-MBs. In 98 cases with survival data, WNT-MBs had a 5-year overall survival (OS) of 68.6%. SHH-MBs TP53wt type and non-WNT/non-SHH-MBs showed 5-year OS of 80.4% and 70.8%, respectively. TP53-mutant SHH-MBs represented a prognostically unfavorable entity; all patients died within 5 years. Patients with a WCA signature showed significantly increased OS (p = 0.011 for SHH-TP53wt-MBs and p = 0.048 for non-WNT/non-SHH-MBs).
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Affiliation(s)
- Tobias Goschzik
- From the Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Anja Zur Muehlen
- From the Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Evelyn Doerner
- From the Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Andreas Waha
- From the Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Carsten Friedrich
- Division of Pediatric Oncology and Hematology, University Children's Hospital Rostock, Rostock, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Torsten Pietsch
- From the Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
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Oud MS, Volozonoka L, Friedrich C, Kliesch S, Nagirnaja L, Gilissen C, O'Bryan MK, McLachlan RI, Aston KI, Tüttelmann F, Conrad DF, Veltman JA. Lack of evidence for a role of PIWIL1 variants in human male infertility. Cell 2021; 184:1941-1942. [PMID: 33861957 PMCID: PMC7614813 DOI: 10.1016/j.cell.2021.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/09/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- M S Oud
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L Volozonoka
- Scientific Laboratory of Molecular Genetics, Riga Stradins University, LV-1007, Riga, Latvia
| | - C Friedrich
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - S Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - L Nagirnaja
- Division of Genetics, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - C Gilissen
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M K O'Bryan
- School of Biological Sciences, Monash University, Clayton, Melbourne, Australia; School of BioSciences, Faculty of Science, The University of Melbourne, Parkville, Melbourne, Australia
| | - R I McLachlan
- Hudson Institute of Medical Research, Clayton, Melbourne, Australia; Department of Obstetrics and Gynecology, Monash University, Clayton, Melbourne, Australia
| | - K I Aston
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - F Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - D F Conrad
- Division of Genetics, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - J A Veltman
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
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Salem M, Friedrich C, Herbers L, Reimers J, Friedrichs A, Lutter G, Thiem A, Panholzer B, Puehler T, Schoettler J, Frank D, Schoeneich F, Cremer J, Haneya A. Surgical Treatment for Active Infective Prosthetic Valve Endocarditis: A Single-Center Experience. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725753] [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: 10/21/2022]
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Salem M, Friedrich C, Herbers L, Reimers J, Friedrichs A, Panholzer B, Thiem A, Puehler T, Cremer J, Haneya A. Risk Factors and Predictors of Mortality after Surgery for Infective Endocarditis. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725665] [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: 10/21/2022]
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Peng J, Boekhoff S, Eveslage M, Bison B, Sowithayasakul P, Friedrich C, Müller HL. Nuchal Skinfold Thickness in Pediatric Brain Tumor Patients. Front Endocrinol (Lausanne) 2021; 12:772856. [PMID: 34975750 PMCID: PMC8716728 DOI: 10.3389/fendo.2021.772856] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/26/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Severe obesity and tumor relapse/progression have impact on long-term prognosis in pediatric brain tumor patients. METHODS In a cross-sectional study, we analyzed nuchal skinfold thickness (NST) on magnetic-resonance imaging (MRI) follow-up monitoring as a parameter for assessment of nuchal adipose tissue in 177 brain tumor patients (40 World Health Organization (WHO) grade 1-2 brain tumor; 31 grade 3-4 brain tumor; 106 craniopharyngioma), and 53 healthy controls. Furthermore, body mass index (BMI), waist-to-height ratio, caliper-measured skinfold thickness, and blood pressure were analyzed for association with NST. RESULTS Craniopharyngioma patients showed higher NST, BMI, waist-to-height ratio, and caliper-measured skinfold thickness when compared to other brain tumors and healthy controls. WHO grade 1-2 brain tumor patients were observed with higher BMI, waist circumference and triceps caliper-measured skinfold thickness when compared to WHO grade 3-4 brain tumor patients. NST correlated with BMI, waist-to-height ratio, and caliper-measured skinfold thickness. NST, BMI and waist-to-height ratio were associated with increased blood pressure. In craniopharyngioma patients with hypothalamic involvement/lesion or gross-total resection, rate and degree of obesity were increased. CONCLUSIONS NST could serve as a novel useful marker for regional nuchal adipose tissue. NST is highly associated with body mass and waist-to-height ratio, and easily measurable in routine MRI monitoring of brain tumor patients.
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Affiliation(s)
- Junxiang Peng
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital, Würzburg, Germany
| | - Panjarat Sowithayasakul
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany
| | - Hermann L. Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany
- *Correspondence: Hermann L. Müller,
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Friedrich C, Salem M, Puehler T, Panholzer B, Herbers L, Reimers J, Friedrichs A, Thiem A, Cremer J, Haneya A. Gender-Related 30-Day and Long-Term Surgical Outcome in Patients with Infective Endocarditis. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725663] [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: 10/21/2022]
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Obrecht D, Mynarek M, Hagel C, Kwiecien R, Spohn M, Bockmayr ML, Bison B, Warmuth-Metz M, Pfister SM, Jones DTW, Sturm D, von Deimling A, Sahm F, von Hoff K, Juhnke BO, Benesch M, Gerber NU, von Bueren AO, Friedrich C, Kortmann RD, Schwarz R, Pietsch T, Rutkowski S. MBCL-09. ISOLATED M1 METASTASES IN PEDIATRIC MEDULLOBLASTOMA: IS POSTOPERATIVE RADIOTHERAPY FOLLOWED BY MAINTENANCE CHEMOTHERAPY SUPERIOR TO POSTOPERATIVE SANDWICH-CHEMOTHERAPY AND RADIOTHERAPY? Neuro Oncol 2020. [PMCID: PMC7715719 DOI: 10.1093/neuonc/noaa222.485] [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 Impact of isolated spread into the cerebrospinal fluid (CSF) is still not investigated comprehensively for childhood medulloblastoma and the best therapeutic strategy is currently unclear. MATERIAL AND METHODS Sixty-six patients with isolated M1-MB registered to the HIT-MED-database from 2000–2018 were identified. CSF and MRI were centrally reviewed for all patients. Patients were stratified by age and either treated with upfront craniospinal irradiation (CSI) followed by maintenance chemotherapy (CT) or with postoperative CT and delayed CSI. RESULTS Forty-nine patients were non-infants ≥4 years and seventeen were infants <4 years. Median age was 7.3y (1.1–18.0). 83.3% were histologically classified as CMB, 12.1% as LCA-MB and 4.6% as DMB. Molecular subgroup was Gr.3 in 25.8%, Gr.4 in 28.8%, SHH in 4.5%, WNT in 1.5% and not evaluated for 39.4%. Lumbar puncture was performed on median postoperative day 19 (range: 14–77). Median follow-up for survivors was 7.6y (range: 1.2–15.9). The whole cohort showed a 3y- and 5y-PFS of 68.0(±6.0) and 60.0(±6.5)%, while OS was 79.1(±5.2) and 72.9(± 5.9)%. 10y-OS was 54.4(±7.5). Patients with upfront CSI had more favourable outcomes (5y-PFS 66.1 vs. 55.8% [p=0.119]; 5y-OS 90.6 vs. 64.5% [p=0.035]). The trend towards improved survival in patients with postoperative CSI was retained when only non-infants were considered (pPFS=0.176, pOS=0.055). M1-persistence occurred exclusively in patients with postoperative CT. CONCLUSION Isolated M1-MB is rare. Patients without contraindication for CSI appear to benefit from treatment by upfront CSI followed by maintenance CT, while cumulative CT-doses would be reduced compared to sandwich strategies.
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Affiliation(s)
- Denise Obrecht
- Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Mynarek
- Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Hagel
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Michael Spohn
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Kinderkrebs-Zentrum Hamburg, Hamburg, Germany
| | - Michael L Bockmayr
- Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Kinderkrebs-Zentrum Hamburg, Hamburg, Germany
| | - Brigitte Bison
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Stefan M Pfister
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - David T W Jones
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dominik Sturm
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Katja von Hoff
- Charite – University Medical Center Berlin, Berlin, Germany
| | - B - Ole Juhnke
- Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Nicolas U Gerber
- Department of Oncology, University Children’s Hospital, Zürich, Switzerland
| | - André O von Bueren
- Department of Pediatrics, Obstetrics and Gynecology, Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Carsten Friedrich
- Division of Pediatric Oncology and Hematology, University Children’s Hospital Rostock, Rostock, Germany
| | - Rolf-Dieter Kortmann
- Department for Radiation Therapy, University Medical Center Leipzig, Leipzig, Germany
| | - Rudolf Schwarz
- Department for Radiotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, Brain Tumor Reference Center of the German Society for Neuropathology and Neuroanatomy (DGNN), University of Bonn, DZNE German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Stefan Rutkowski
- Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Hagel C, Sloman V, Mynarek M, Petrasch K, Obrecht D, Deinlein F, Schmid R, von Bueren AO, Friedrich C, Juhnke BO, Gerber NU, Kwiecien R, Girschick H, Höller A, Zapf A, von Hoff K, Rutkowski S. PATH-07. QUALITY ASSURANCE IN CEREBROSPINAL FLUID CYTOLOGY ASSESSMENT FOR MEDULLOBLASTOMA STAGING LEADS TO POTENTIAL IMPROVED RISK-GROUP ASSESSMENT IN THE PROSPECTIVE MULTICENTER HIT-2000 TRIAL. Neuro Oncol 2020. [PMCID: PMC7715284 DOI: 10.1093/neuonc/noaa222.643] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Cerebrospinal fluid (CSF) dissemination of medulloblastoma (M1 stage) is a high-risk prognostic factor. However, because diagnostic criteria for M1 staging are missing we specified process-related and cytomorphological parameters influencing the predictive value of the CSF status.
PATIENTS AND METHODS
CSF samples and cytology reports from 405 medulloblastoma patients of the prospective multicenter trial HIT-2000 were reviewed and related to 5-year progression free survival (5y-PFS).
RESULTS
Tumor cells were detected in 237/1073 CSF cytospins. M1-patients and M2/3 patients with radiologically detected metastases showed a worse 5y-PFS than M0 patients (54% and 52% vs. 76%; p=0.01 and p<0.001). Lumbar sampling was more sensitive than ventricular sampling. M0 diagnosed specimens containing >50% lytic cells and/or less than 10 nucleated cells showed a decreased 5y-PFS (61%). Further investigation of cytological parameters revealed a poor outcome for cases harboring > 3 tumor cell clusters and individual tumor cells (5y-PFS 33%) vs. cases with ≥ 2 individual tumor cells but no clusters (5y-PFS 61%). In bi-variable Cox-regression, ≥ 2 vs. 0 or 1 tumor cells were associated with a Hazard Ratio (HR) of 0.52 (95%-Confidence Interval (CI): 0.12, 2.30; p=0.39), whereas > 3 vs. no tumor cell clusters were associated with a HR of 8.94 (95%-CI: 1.66, 48.22; p=0.01).
CONCLUSIONS
CSF staging in medulloblastoma should comprise lumbar specimens with <50% lytic cells and a minimum of 10 nucleated cells. The predictive value of CSF cytology in M1 cases may predominantly depend on tumor cell clusters. The latter finding needs to be confirmed in prospective trials.
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Affiliation(s)
- Christian Hagel
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Veronika Sloman
- Department of Pediatric Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Mynarek
- Department of Pediatric Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Petrasch
- Department of Pediatric Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Denise Obrecht
- Department of Pediatric Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Deinlein
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Wuerzburg, Wuerzburg, Germany
| | - Renate Schmid
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Wuerzburg, Wuerzburg, Germany
| | - André O von Bueren
- Department of Pediatrics, Obstetrics and Gynecology, Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Carsten Friedrich
- Division of Pediatric Oncology and Hematology, University Children’s Hospital Rostock, Rostock, Germany
| | - B Ole Juhnke
- Department of Pediatric Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolas U Gerber
- Department of Oncology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Robert Kwiecien
- Institut für Biometrie und Klinische Forschung, Universitätsklinikum Münster, Münster, Germany
| | - Hermann Girschick
- Kinder- und Jugendmedizin, Vivantes-Klinikum, Berlin Friedrichshain, Berlin, Germany
| | - Alexandra Höller
- Institute of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Rutkowski
- Department of Pediatric Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
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Mynarek M, von Hoff K, Pietsch T, Ottensmeier H, Warmuth-Metz M, Bison B, Pfister S, Korshunov A, Sharma T, Jaeger N, Ryzhova M, Zheludkova O, Golanov A, Rushing EJ, Hasselblatt M, Koch A, Schüller U, von Deimling A, Sahm F, Sill M, Riemenschneider MJ, Dohmen H, Monoranu CM, Sommer C, Staszewski O, Mawrin C, Schittenhelm J, Brück W, Filipski K, Hartmann C, Meinhardt M, Pietschmann K, Haberler C, Slavc I, Gerber NU, Grotzer M, Benesch M, Schlegel PG, Deinlein F, von Bueren AO, Friedrich C, Obrecht D, Fleischhack G, Kwiecien R, Faldum A, Kortmann RD, Kool M, Rutkowski S. MBCL-07. NON-METASTATIC MEDULLOBLASTOMA OF EARLY CHILDHOOD: RESULTS FROM THE PROSPECTIVE CLINICAL TRIAL HIT-2000 AND AN EXTENDED VALIDATION COHORT. Neuro Oncol 2020. [PMCID: PMC7715606 DOI: 10.1093/neuonc/noaa222.483] [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
OBJECTIVE To avoid craniospinal irradiation (CSI) in children younger than four years with non-metastatic medulloblastoma by chemotherapy, intraventricular methotrexate and risk-adapted local radiotherapy. PATIENTS AND METHODS Eighty-seven patients received systemic chemotherapy and intraventricular methotrexate. Until 2006, CSI was reserved for non-response or progression. After 2006, local radiotherapy was introduced for non-responders or classic (CMB), anaplastic or large-cell medulloblastoma (LCA). Infantile SHH-activated medulloblastomas (SHH_INF) were subdivided by DNA-methylation profiling. Survival in SHH_INF subtypes were also assessed in a validation cohort (n=71). RESULTS Patients with desmoplastic medulloblastoma (DMB) or medulloblastoma with extensive nodularity (MBEN) (n=42) had 93% 5-year PFS, 100% 5-year OS and 93% 5-year CSI-free survival. Patients with CMB/LCA (n=45) had 37% 5y-PFS, 62% 5y-OS and 39% 5y-CSI-free survival. Local radiotherapy did not improve survival in CMB/LCA patients. All DMB/MBEN assessed by DNA methylation profiling belonged to the SHH_INF subgroup. Group 3 patients (5y-PFS 36% [n=14]) relapsed more frequently than SHH_INF (5y-PFS 93% [n=28]) or Group 4 patients (5y-PFS 83% [n=6], p<0.001). SHH_INF split into iSHH-I and iSHH-II subtypes in HIT-2000-BIS4 and the validation cohort, without prognostic impact (5y-PFS: iSHH-I 73% vs. iSHH-II 83%, p=0.25, n=99). Mean IQ was 90 (radiotherapy-free survivors) vs. 74 (patients that received CSI) [p=0.012]. CONCLUSION Systemic chemotherapy and intraventricular methotrexate led to favorable survival in both iSHH-subtypes of SHH-activated DMB/MBEN with acceptable neurotoxicity. Survival in non-WNT/non-SHH CMB/LCA patients was not improved by local radiotherapy. Survival was more favorable in patients with Group 4 than in patients with Group 3 medulloblastoma.
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Affiliation(s)
- Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- Department of Pediatric Oncology, Hematology and Stem Cell Transplantation, Charite – University Medical Center Berlin, Berlin, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, Brain Tumor Reference Center of the German Society for Neuropathology and Neuroanatomy (DGNN), University of Bonn, DZNE German Center for Neurodegenerative Disease, Bonn, Germany
| | - Holger Ottensmeier
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Wuerzburg, Wuerzburg, Germany
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Brigitte Bison
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Stefan Pfister
- Hopp Children’s Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology (B300), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tanvi Sharma
- Hopp Children’s Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Natalie Jaeger
- Hopp Children’s Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Marina Ryzhova
- Department of Neuropathology, N.N. Burdenko Neurosurgical Institute, Moscow, Russian Federation
| | - Olga Zheludkova
- Department of Pediatric Oncology, Russian Scientific Center of Roentgenoradiology, Moscow, Russian Federation
| | - Andrey Golanov
- Department of Stereotactic Radiotherapy and Radiosurgery National Medical Research Center of Neurosurgery named after N.N. Burdenko, Moscow, Germany
| | | | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Muenster, Muenster, Germany
| | - Arend Koch
- Department of Neuropathology, Charite – University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology (B300), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Sahm
- Hopp Children’s Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Sill
- Hopp Children’s Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | | | - Hildegard Dohmen
- Institute for Neuropathology, University Hospital Gießen and Marburg, Gießen, Germany
| | - Camelia-Maria Monoranu
- Institute of Pathology, Department of Neuropathology, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Center (CCC) Mainfranken, Wuerzburg, Germany
| | - Clemens Sommer
- Institute for Neuropathology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ori Staszewski
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme for Advanced Clinician Scientists, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Mawrin
- Institute for Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Institute for Pathology and Neuropathology, University Medical Center Tuebingen, Tuebingen, Germany
| | - Wolfgang Brück
- Institute for Neuropathology, University Medical Center Goettingen, Goettingen, Germany
| | - Katharina Filipski
- Institute of Neurology (Edinger Institute), University Hospital, Frankfurt Am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute for Pathology, Hannover Medical Schoo, Hannover, Germany
| | - Matthias Meinhardt
- Institute for Pathology, University Medical Center Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - Christine Haberler
- Institute of Neurology, and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- epartment of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Nicolas U Gerber
- Department of Oncology, University Children’s Hospital, Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital, Zurich, Switzerland
| | - Michael Grotzer
- Department of Oncology, University Children’s Hospital, Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital, Zurich, Switzerland
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Wuerzburg, Wuerzburg, Germany
| | - Frank Deinlein
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Wuerzburg, Wuerzburg, Germany
| | - André O von Bueren
- Department of Pediatrics, Obstetrics and Gynecology, Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
- Department of Pediatrics, CANSEARCH Research Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Carsten Friedrich
- Division of Pediatric Oncology and Hematology, University Children’s Hospital Rostock, Rostock, Germany
| | - Denise Obrecht
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Gudrun Fleischhack
- Paediatric Haematology and Oncology, Paediatrics III, University Hospital of Essen, Essen, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | | | - Marcel Kool
- Hopp Children’s Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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Juhnke BO, Gessi M, Gerber NU, Friedrich C, Haberler C, Mynarek M, Bison B, Kortmann RD, Warmuth-Metz M, Schüller U, Pfister SM, Pietsch T, Kool M, Rutkowski S, von Hoff K. ETMR-14. TREATMENT OF EMBRYONAL TUMOURS WITH MULTILAYERED ROSETTES (ETMR) WITH CARBOPLATIN-ETOPOSIDE INDUCTION AND TANDEM HIGH-DOSE CHEMOTHERAPY WITHIN THE PROSPECTIVE HIT-TRIALS AND REGISTRIES. Neuro Oncol 2020. [PMCID: PMC7715692 DOI: 10.1093/neuonc/noaa222.218] [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
BACKGROUND
Embryonal tumours with multilayered rosettes (ETMR) are highly aggressive tumors, mostly occurring in infants. Published clinical data refer to retrospective cohorts of inhomogeneously treated patients. Here, we describe the outcome of patients, who were prospectively treated within the P-HIT2000-trial, the subsequent HIT2000-interim-registry and earlier HIT-trials.
PATIENTS AND METHODS
Nineteen patients from the P-HIT2000-trial (2001–2011), 12 patients from the subsequent HIT2000-interim-registry (2012–2014) and 4 patients from earlier HIT-trials with centrally reviewed neuropathological and molecularly-confirmed diagnosis of ETMR were included. Outcome of 18 patients treated with carboplatin-etoposide-induction followed by tandem-high-dose chemotherapy (“CARBO-ETO+HDCT”) with stage-stratified radiotherapy administered in case of persistant disease, relapse or progression were compared to patients treated with HIT-SKK chemotherapy ± radiotherapy (n=9) or other regimens (n=8).
RESULTS
Median age at diagnosis was 2.9(1.0–5.3) years. Metastases at diagnosis were detected in 9 patients (26%). For the entire cohort of n=35, 5-year overall survival (OS) was 26.7%, and progression-free survival (PFS) was 18.5%. Five-year OS for patients with CARBO-ETO+HDCT, SKK chemotherapy or other regimens was 44.4%, 13.0% and 0%, respectively (p=0.006). Five-year PFS was 33.3%, 0% and 0%, respectively (p=0.119). Of 10 survivors, n=8 were treated with CARBO-ETO+HDCT; n=4 had craniospinal, n=2 local and n=4 no radiotherapy. Impact of initial gross-total-resection (p=0.231) and non-metastatic disease (p=0.097) was limited.
CONCLUSIONS
We show improved survival with carboplatin-etoposide-induction followed by tandem-high-dose chemotherapy, indicating that a cure is possible for some patients. However, despite intensive treatment, outcome is unsatisfactory and innovative therapies urgently need to be included in an upfront setting.
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Affiliation(s)
- Björn-Ole Juhnke
- Clinic for Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Gessi
- Neuropathology Unit, Division of Pathology, Fondazione Policlinico Universitario “A Gemelli” IRCCS, Catholic University, Rome, Italy
| | | | - Carsten Friedrich
- Children’s Clinic, University Medical Centre Rostock, Rostock, Germany
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Martin Mynarek
- Clinic for Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Brigitte Bison
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | | | - Monika Warmuth-Metz
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich Schüller
- Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Michael Pfister
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Division of Paediatric Neurooncology, German Cancer Research Centre (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, DGNN Brain Tumour Reference Centre, University Hospital Bonn, Bonn, Germany
| | - Marcel Kool
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Division of Paediatric Neurooncology, German Cancer Research Centre (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Stefan Rutkowski
- Clinic for Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Paediatric Oncology and Haematology, Charité University Medicine, Berlin, Germany
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van der Bijl N, Röpke A, Biswas U, Wöste M, Jessberger R, Kliesch S, Friedrich C, Tüttelmann F. Mutations in the stromal antigen 3 (STAG3) gene cause male infertility due to meiotic arrest. Hum Reprod 2020; 34:2112-2119. [PMID: 31682730 DOI: 10.1093/humrep/dez204] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 05/13/2019] [Revised: 07/18/2019] [Indexed: 01/18/2023] Open
Abstract
STUDY QUESTION Are sequence variants in the stromal antigen 3 (STAG3) gene a cause for non-obstructive azoospermia (NOA) in infertile human males? SUMMARY ANSWER Sequence variants affecting protein function of STAG3 cause male infertility due to meiotic arrest. WHAT IS KNOWN ALREADY In both women and men, STAG3 encodes for a meiosis-specific protein that is crucial for the functionality of meiotic cohesin complexes. Sequence variants in STAG3 have been reported to cause meiotic arrest in male and female mice and premature ovarian failure in human females, but not in infertile human males so far. STUDY DESIGN, SIZE, DURATION The full coding region of STAG3 was sequenced directly in a cohort of 28 men with NOA due to meiotic arrest. In addition, a larger group of 275 infertile men that underwent whole-exome sequencing (WES) was screened for potential STAG3 sequence variants. Furthermore, meiotic spreads, immunohistochemistry, WES and population sampling probability (PSAP) have been conducted in the index case. PARTICIPANTS/MATERIALS, SETTING, METHODS This study included 28 infertile but otherwise healthy human males who underwent Sanger sequencing of the full coding region of STAG3. Additionally, WES data of 275 infertile human males with different infertility phenotypes have been screened for relevant STAG3 variants. All participants underwent karyotype analysis and azoospermia factor (AZF) screening in advance. In the index patient, segregation analysis, WES data, PSAP, lab parameters, testis histology and nuclear spreads have been added to suplort the findings. MAIN RESULTS AND THE ROLE OF CHANCE Two compound-heterozygous variants in STAG3 (c.[1262T>G];[1312C>T], p.[(Leu421Arg)];[(Arg438Ter)]) have been found to cause male infertility due to complete bilateral meiotic arrest in an otherwise healthy human male. Compound heterozygosity was confirmed by Sanger sequencing of the parents and the patient's brother. Other variants which may affect spermatogenesis have been ruled out through analysis of the patient's WES data and application of the PSAP pipeline. As expected from Stag3 knockout-mice meiotic spreads, germ cells did not develop further than zygotene and showed drastic chromosome aberrations. No rare variants in STAG3 were found in the 275 infertile males with other phenotypes. Our results indicate that STAG3 variants that negatively affect its protein function are a rare cause of NOA (<1% of cases). LIMITATIONS, REASONS FOR CAUTION We identified only one patient with compound-heterozygous variants in STAG3 causing NOA due to meiotic arrest. Future studies should evaluate STAG3 variants in larger cohorts to support this finding. WIDER IMPLICATIONS OF THE FINDINGS Identification of STAG3 sequence variants in infertile human males should improve genetic counselling as well as diagnostics and treatment. Especially before testicular sperm extraction (TESE) for ICSI, STAG3 variants should be ruled out to prevent unnecessary interventions with frustrating outcomes for both patients and clinicians. STUDY FUNDING/COMPETING INTEREST(S) This work was carried out within the frame of the German Research Foundation (DFG) Clinical Research Unit 'Male Germ Cells: from Genes to Function' (CRU326). Work in the laboratory of R.J. is supported by a grant of the European Union H2020 program GermAge. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- N van der Bijl
- Institute of Human Genetics, University of Münster, 48149 Münster, Germany
| | - A Röpke
- Institute of Human Genetics, University of Münster, 48149 Münster, Germany
| | - U Biswas
- Institute of Physiological Chemistry, TU Dresden, 01307 Dresden, Germany
| | - M Wöste
- Institute of Medical Informatics, University of Münster, 48149 Münster, Germany
| | - R Jessberger
- Institute of Physiological Chemistry, TU Dresden, 01307 Dresden, Germany
| | - S Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University Hospital Münster, 48149 Münster, Germany
| | - C Friedrich
- Institute of Human Genetics, University of Münster, 48149 Münster, Germany
| | - F Tüttelmann
- Institute of Human Genetics, University of Münster, 48149 Münster, Germany
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Friedrich C, Helmstädter A. Seventy-five volumes of " Die Pharmazie" - a historical review. Pharmazie 2020; 75:289-293. [PMID: 32635968 DOI: 10.1691/ph.2020.0449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The journal "Die Pharmazie" was founded shortly after World War II in the German Sovjet occupation zone, and made its way to the leading pharmaceutical journal in the German Democratic Republic. From the early 1960s, and under the editorial responsibility of Siegfried Pfeifer (1961-1993) and Rudolf Voigt (1961-1988), the journal continuously increased its reputation and reached its present status of a peer reviewed international journal. Pfeifer served the journal as an editor-in-chief for 32 years in total. Other long-time editors were Peter Pflegel (1989-2012) and Theodor Dingermann (since 1994). Between 1946 and 2019 more than 12.000 manuscripts from almost 120 countries were published. From the very beginning up to the present day, "Die Pharmazie" has been accepting papers from all the pharmaceutical disciplines. The journal made history by publishing the first description of the thin layer chromatography technique and personal accounts of Arthur Eichengrün, personally involved in the discovery of aspirin.
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Affiliation(s)
- C Friedrich
- Institute for the History of Pharmacy, Philipps-University, Marburg
| | - A Helmstädter
- Institute of Pharmaceutical Chemistry, Goethe University, Frankfurt am Main; Avoxa - Mediengruppe Deutscher Apotheker GmbH, Eschborn, Germany;,
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Mynarek M, von Hoff K, Pietsch T, Ottensmeier H, Warmuth-Metz M, Bison B, Pfister S, Korshunov A, Sharma T, Jaeger N, Ryzhova M, Zheludkova O, Golanov A, Rushing EJ, Hasselblatt M, Koch A, Schüller U, von Deimling A, Sahm F, Sill M, Riemenschneider MJ, Dohmen H, Monoranu CM, Sommer C, Staszewski O, Mawrin C, Schittenhelm J, Brück W, Filipski K, Hartmann C, Meinhardt M, Pietschmann K, Haberler C, Slavc I, Gerber NU, Grotzer M, Benesch M, Schlegel PG, Deinlein F, von Bueren AO, Friedrich C, Juhnke BO, Obrecht D, Fleischhack G, Kwiecien R, Faldum A, Kortmann RD, Kool M, Rutkowski S. Nonmetastatic Medulloblastoma of Early Childhood: Results From the Prospective Clinical Trial HIT-2000 and An Extended Validation Cohort. J Clin Oncol 2020; 38:2028-2040. [PMID: 32330099 DOI: 10.1200/jco.19.03057] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The HIT-2000-BIS4 trial aimed to avoid highly detrimental craniospinal irradiation (CSI) in children < 4 years of age with nonmetastatic medulloblastoma by systemic chemotherapy, intraventricular methotrexate, and risk-adapted local radiotherapy. PATIENTS AND METHODS From 2001-2011, 87 patients received systemic chemotherapy and intraventricular methotrexate. Until 2006, CSI was reserved for nonresponse or progression. After 2006, local radiotherapy was introduced for nonresponders or patients with classic medulloblastoma (CMB) or large-cell/anaplastic medulloblastoma (LCA). DNA methylation profiles of infantile sonic hedgehog-activated medulloblastoma (SHH-INF) were subdivided into iSHH-I and iSHH-II subtypes in the HIT-2000-BIS4 cohort and a validation cohort (n = 71) from the HIT group and Russia. RESULTS Five years after diagnosis, patients with desmoplastic medulloblastoma (DMB) or medulloblastoma with extensive nodularity (MBEN; n = 42) had 93% progression-free survival (5y-PFS), 100% overall survival (5y-OS), and 93% CSI-free (5y-CSI-free) survival. Patients with CMB/LCA (n = 45) had 37% 5y-PFS, 62% 5y-OS, and 39% 5y-CSI-free survival. Local radiotherapy did not improve survival in patients with CMB/LCA. All DMB/MBEN assessed by DNA methylation profiling belonged to the SHH-INF subgroup. Group 3 patients (5y-PFS, 36%; n = 14) relapsed more frequently than the SHH-INF group (5y-PFS, 93%; n = 28) or group 4 patients (5y-PFS, 83%; n = 6; P < .001). SHH-INF split into iSHH-I and iSHH-II subtypes in HIT-2000-BIS4 and the validation cohort, without prognostic impact (5y-PFS: iSHH-I, 73%, v iSHH-II, 83%; P = .25; n = 99). Intelligence quotient (IQ) was significantly lower in patients after CSI (mean IQ, 90 [no radiotherapy], v 74 [CSI]; P = .012). CONCLUSION Systemic chemotherapy and intraventricular methotrexate led to favorable survival in both iSHH subtypes of SHH-activated DMB/MBEN with acceptable neurotoxicity. Survival in patients with non-wingless (WNT)/non-SHH disease with CMB/LCA was not improved by local radiotherapy. Patients with group 4 disease had more favorable survival rates than those with group 3 medulloblastoma.
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Affiliation(s)
- Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Pediatric Oncology, Hematology and Stem Cell Transplantation, Charite - University Medical Center Berlin, Berlin, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, Brain Tumor Reference Center of the German Society for Neuropathology and Neuroanatomy, University of Bonn, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Holger Ottensmeier
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg, Wuerzburg, Germany
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Brigitte Bison
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Stefan Pfister
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center; and Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tanvi Sharma
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Natalie Jaeger
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
| | - Marina Ryzhova
- Department of Neuropathology, N. N. Burdenko Neurosurgical Institute, Moscow, Russia
| | - Olga Zheludkova
- Department of Pediatric Oncology, Russian Scientific Center of Roentgenoradiology, Moscow, Russia
| | - Andrey Golanov
- Department of Stereotactic Radiotherapy and Radiosurgery, N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | | | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Muenster, Muenster, Germany
| | - Arend Koch
- Department of Neuropathology, Charite - University Medical Center Berlin, Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neuropathology, University Medical Center Hamburg-Eppendorf; and Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center; and Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Sahm
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center; and Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
| | | | - Hildegard Dohmen
- Institute for Neuropathology, University Hospital Gießen and Marburg, Gießen, Germany
| | - Camelia Maria Monoranu
- Institute of Pathology, Department of Neuropathology, University of Wuerzburg; and Comprehensive Cancer Center Mainfranken, Wuerzburg, Germany
| | - Clemens Sommer
- Institute for Neuropathology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ori Staszewski
- Institute of Neuropathology and Berta-Ottenstein-Programme for Advanced Clinician Scientists, University of Freiburg, Freiburg, Germany
| | - Christian Mawrin
- Institute for Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Institute for Pathology and Neuropathology, University Medical Center Tuebingen, Tuebingen, Germany
| | - Wolfgang Brück
- Institute for Neuropathology, University Medical Center Goettingen, Goettingen, Germany
| | - Katharina Filipski
- Institute of Neurology (Edinger Institute), University Hospital, Frankfurt Am Main; German Cancer Consortium, Partner Site Frankfurt/Mainz; and German Cancer Research Center, Heidelberg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Matthias Meinhardt
- Institute for Pathology, University Medical Center Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - Christine Haberler
- Institute of Neurology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Nicolas U Gerber
- Department of Oncology and Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | - Michael Grotzer
- Department of Oncology and Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Paul Gerhardt Schlegel
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg, Wuerzburg, Germany
| | - Frank Deinlein
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg, Wuerzburg, Germany
| | - André O von Bueren
- Department of Pediatrics, Obstetrics and Gynecology, Division of Pediatric Hematology and Oncology, University Hospital of Geneva; and Department of Pediatrics, CANSEARCH Research Laboratory, University of Geneva, Geneva, Switzerland
| | - Carsten Friedrich
- Division of Pediatric Oncology and Hematology, University Children's Hospital Rostock, Rostock, Germany
| | - Björn-Ole Juhnke
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Denise Obrecht
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gudrun Fleischhack
- Pediatric Hematology and Oncology, Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | | | - Marcel Kool
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Roch S, Friedrich C, Brinker A. Uptake routes of microplastics in fishes: practical and theoretical approaches to test existing theories. Sci Rep 2020; 10:3896. [PMID: 32127589 PMCID: PMC7054251 DOI: 10.1038/s41598-020-60630-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/14/2020] [Indexed: 02/01/2023] Open
Abstract
Microplastics are frequently detected in the gastrointestinal tracts of aquatic organisms worldwide. A number of active and passive pathways have been suggested for fish, including the confusion of microplastic particles with prey, accidental uptake while foraging and transfer through the food chain, but a holistic understanding of influencing factors is still lacking. The aim of the study was to investigate frequently suggested theories and identify relevant biotic factors, as well as certain plastic properties, affecting microplastic intake in fish. Four species of freshwater fish, each representing a different combination of foraging style (visual/chemosensory) and domestic status (wild/farmed) were exposed to different realistic plastic concentrations and polymer types with and without the provision of genuine food. As most previous investigations of microplastic uptake routes consider only particles large enough to be perceptible to fish, the potential for accidental intake via drinking water has been somewhat neglected. This route is evaluated in the current study using a model approach. The results show that visually oriented fish forage actively on microplastic particles that optically resemble their usual food, while fish with a predominantly chemosensory foraging style are more able to discriminate inedible food items. Even so, the accidental uptake of microplastics while foraging is shown to be relevant pathway, occurring frequently in both visual and chemosensory foragers alike. Several factors were shown to increase plastic uptake, including microplastic concentration in the water, foraging behaviour promoted by availability of genuine food, and fish size. Although both wild and farmed fish ingested microplastic particles, cultured fish showed less discernment in terms of colour and were more likely to forage actively on microplastics when no food was available. Drinking has been identified as a possible source of microplastic intake specifically for large marine fish species. Particles smaller than <5 µm can pass the gastrointestinal tract wall and bioaccumulation could arise when uptake exceeds release or when particles are assimilated in tissues or organs. The effects of accumulation may be significant, especially in long-living species, with implications for food web transfer and fish as food items.
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Affiliation(s)
- S Roch
- Fisheries Research Station Baden-Württemberg, Argenweg 50/1, 88085, Langenargen, Germany. .,University of Konstanz, Mainaustraße 252, 78464, Konstanz, Germany.
| | - C Friedrich
- FMF Freiburg Material Research Centre and Institute for Macromolecular Chemistry, University of Freiburg, Stefan-Meier-Straße 21, 79104, Freiburg i. Br., Germany
| | - A Brinker
- Fisheries Research Station Baden-Württemberg, Argenweg 50/1, 88085, Langenargen, Germany.,University of Konstanz, Mainaustraße 252, 78464, Konstanz, Germany
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46
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Ottensmeier H, Schlegel PG, Eyrich M, Wolff JE, Juhnke BO, von Hoff K, Frahsek S, Schmidt R, Faldum A, Fleischhack G, von Bueren A, Friedrich C, Resch A, Warmuth-Metz M, Krauss J, Kortmann RD, Bode U, Kühl J, Rutkowski S. Treatment of children under 4 years of age with medulloblastoma and ependymoma in the HIT2000/HIT-REZ 2005 trials: Neuropsychological outcome 5 years after treatment. PLoS One 2020; 15:e0227693. [PMID: 31971950 PMCID: PMC6977734 DOI: 10.1371/journal.pone.0227693] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/24/2019] [Indexed: 11/24/2022] Open
Abstract
Young children with brain tumours are at high risk of developing treatment-related sequelae. We aimed to assess neuropsychological outcomes 5 years after treatment. This cross-sectional study included children under 4 years of age with medulloblastoma (MB) or ependymoma (EP) enrolled in the German brain tumour trials HIT2000 and HIT-REZ2005. Testing was performed using the validated Wuerzburg Intelligence Diagnostics (WUEP-D), which includes Kaufman-Assessment-Battery, Coloured Progressive Matrices, Visual-Motor Integration, finger tapping “Speed”, and the Continuous Performance Test. Of 104 patients in 47 centres, 72 were eligible for analyses. We assessed whether IQ was impacted by disease extent, disease location, patient age, gender, age at surgery, and treatment (chemotherapy with our without craniospinal irradiation [CSI] or local radiotherapy [LRT]). Median age at surgery was 2.3 years. Testing was performed at a median of 4.9 years after surgery. Patients with infratentorial EPs (treated with LRT) scored highest in fluid intelligence (CPM 100.9±16.9, mean±SD); second best scores were achieved by patients with MB without metastasis treated with chemotherapy alone (CPM 93.9±13.2), followed by patients with supratentorial EPs treated with LRT. In contrast, lowest scores were achieved by patients that received chemotherapy and CSI, which included children with metastasised MB and those with relapsed MB M0 (CPM 71.7±8.0 and 73.2±21.8, respectively). Fine motor skills were reduced in all groups. Multivariable analysis revealed that type of treatment had an impact on IQ, but essentially not age at surgery, time since surgery or gender. Our results confirm previous reports on the detrimental effects of CSI in a larger cohort of children. Comparable IQ scores in children with MB treated only with chemotherapy and in children with EP suggest that this treatment strategy represents an attractive option for children who have a high chance to avoid application of CSI. Longitudinal follow-up examinations are warranted to assess long-term neuropsychological outcomes.
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Affiliation(s)
- Holger Ottensmeier
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
- * E-mail:
| | - Paul G. Schlegel
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Medical Center, Wuerzburg, Germany
| | - Matthias Eyrich
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
| | - Johannes E. Wolff
- AbbvVie, Oncology Development, Chicago, Illinois, United States of America
| | - Björn-Ole Juhnke
- Department of Paediatric Haematology and Oncology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Paediatric Haematology and Oncology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Frahsek
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
| | - Rene Schmidt
- Institute of Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | | | - Andre von Bueren
- Department of Paediatrics and Adolescent Medicine Division of Paediatric Haematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Carsten Friedrich
- Department of Haematology Oncology, University Children´s Hospital Rostock, Rostock, Germany
| | - Anika Resch
- Department of Haematology Oncology, University Children´s Hospital Rostock, Rostock, Germany
| | - Monika Warmuth-Metz
- Department of Neuroradiology, HIT 2000 National Reference Center, University Medical Center Wuerzburg, Wuerzburg, Germany
| | - Jürgen Krauss
- Department of Paediatric Neurosurgery, University of Wuerzburg, University Medical Center Wuerzburg, Wuerzburg, Germany
| | - Rolf D. Kortmann
- Department of Radiotherapy, University of Leipzig, Leipzig, Germany
| | - Udo Bode
- Department of Paediatric Oncology, University of Bonn, Bonn, Germany
| | - Joachim Kühl
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
| | - Stefan Rutkowski
- Department of Paediatric Haematology and Oncology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
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Kapahnke J, Huenges K, Salem M, Kolat P, Schoettler J, Schoeneich F, Puehler T, Friedrich C, Cremer J, Haneya A. The Circulatory Arrest Time in Patients with Acute Type A Aortic Dissection: Does It Influence the Outcome? Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705505] [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: 10/24/2022]
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48
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Araujo TF, Friedrich C, Grangeiro CHP, Martelli LR, Grzesiuk JD, Emich J, Wyrwoll MJ, Kliesch S, Simões AL, Tüttelmann F. Sequence analysis of 37 candidate genes for male infertility: challenges in variant assessment and validating genes. Andrology 2019; 8:434-441. [PMID: 31479588 DOI: 10.1111/andr.12704] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The routine genetic analysis for diagnosing male infertility has not changed over the last twenty years, and currently available tests can only determine the etiology of 4% of unselected infertile patients. Thus, to create new diagnostic assays, we must better understand the molecular and genetic mechanisms of male infertility. Although next-generation sequencing allows for simultaneous analysis of hundreds of genes and the discovery of novel candidates related to male infertility, so far only a few gene candidates have enough sound evidence to support the gene-disease relationship. OBJECTIVE Since complementary studies are required to validate genes, we aimed to analyze the presence of potentially pathogenic rare variants in a set of candidate genes related to azoospermia in a hitherto understudied South American population. SUBJECTS AND METHODS We performed whole exome sequencing in a group of 16 patients with non-obstructive azoospermia from Ribeirão Preto, Brazil. Based on a recent systematic review of monogenic causes of male infertility, we selected a set of 37 genes related to azoospermia, Sertoli-Cell-Only histology, and spermatogenic arrest to analyze. The identified variants were confirmed by Sanger sequencing, and their functional consequence was predicted by in silico programs. RESULTS We identified potential pathogenic variants in seven genes in six patients. Two variants, c.671A>G (p.(Asn224Ser)) in DMRT1 and c.91C>T (p.(Arg31Cys)) in REC8, have already been described in association with azoospermia. We also found new variants in genes that already have moderate evidence of being linked to spermatogenic failure (TEX15, KLHL10), in genes with limited evidence (DNMT3B, TEX14) and in one novel promising candidate gene that has no evidence so far (SYCE1L). DISCUSSION Although this study included a small number of patients, the process of rationally selecting genes allowed us to detect rare potentially pathogenic variants, providing supporting evidence for validating candidate genes associated with azoospermia.
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Affiliation(s)
- T F Araujo
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - C Friedrich
- Institute of Human Genetics, University of Münster, Münster, Germany
| | - C H P Grangeiro
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - L R Martelli
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - J D Grzesiuk
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - J Emich
- Institute of Human Genetics, University of Münster, Münster, Germany
| | - M J Wyrwoll
- Institute of Human Genetics, University of Münster, Münster, Germany
| | - S Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University Hospital Münster, Münster, Germany
| | - A L Simões
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - F Tüttelmann
- Institute of Human Genetics, University of Münster, Münster, Germany
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Goschzik T, zur Mühlen A, Dörner E, Waha A, Friedrich C, Hau P, Pietsch T. PATH-32. GENOMIC LANDSCAPE AND BIOLOGY OF MEDULLOBLASTOMA IN ADULTS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Medulloblastoma (MB) is a rare disease in adults. Only few cohorts have been studied so far.
METHODS
Histological features were evaluated and tumors were annotated to WNT-MB, SHH-MB, and non-WNT/non-SHH-MB by immunohistochemistry. Copy number alterations were analyzed by genome-wide molecular inversion probe array. MB-related genes were screened by NGS panel and Sanger sequencing in WNT- and SHH-MB.
RESULTS
The cohort of 117 tumors contained 14.5% WNT-MB, 63.2% SHH-MB, and 22.2% non-WNT/non-SHH-MB. Classic histology was found in WNT-MB, non-WNT/non-SHH-MB and 22% of SHH-MB; 78% of SHH-MB showed desmoplastic/nodular histology. In WNT-MB, CTNNB1 mutations were found in 88.2% and monosomy 6 in 52.9% of cases. In SHH-MB, PTCH1 mutations were present in 40% of cases and chromosome 9q loss including the PTCH1 locus was the most frequent copy number event in SHH-MB (50%), while SMO and SUFU mutations were found only in 15.4% and 7.7%, respectively. TERT promoter mutations were present in 92.3% of SHH-MBs. Only 2 (3%) of SHH-MB were TP53-mutated (1.7% of whole cohort). In non-WNT/non-SHH-MB, isochromosome 17q was the most frequent chromosomal alteration (84.6%). A previously published whole chromosomal aberration (WCA) signature with ≥1 WCA was found in 69.2% of cases. For 87 cases, survival data were available. WNT-MB, SHH-MB with wildtype TP53 and non-WNT/non-SHH-MB showed similar outcomes (5-year OS: 75%, 78.1% and 69.1%, respectively). Both SHH-MB patients with mutant TP53 died of disease. Patients with non-WNT/non-SHH-MB characterized by the cytogenetic WCA phenotype showed – as described in pediatric standard-risk MB – significant better overall survival compared to patients with tumors lacking WCA (p=0.02).
CONCLUSIONS
Adult MB represents four defined biological/genomic entities. While in our cohort WNT-MB and SHH-MB-TP53wt were standard risk, non-WNT/non-SHH-MB patients could be divided into two risk-groups according to the presence or absence of WCA in the tumors as previously published for childhood standard-risk MB.
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Affiliation(s)
- Tobias Goschzik
- University of Bonn, Department of Neuropathology, Bonn, Germany
| | - Anja zur Mühlen
- University of Bonn, Department of Neuropathology, Bonn, Germany
| | - Evelyn Dörner
- University of Bonn, Department of Neuropathology, Bonn, Germany
| | - Andreas Waha
- University of Bonn, Department of Neuropathology, Bonn, Germany
| | - Carsten Friedrich
- University Children’s Hospital Rostock, Division of Pediatric Oncology and Hematology, Rostock, Germany
| | - Peter Hau
- Regensburg University Hospital, Regensburg, Germany
| | - Torsten Pietsch
- University of Bonn Medical School, Department of Neuropathology, Bonn, Germany
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50
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Goschzik T, zur Mühlen A, Dörner E, Waha A, Friedrich C, Hau P, Pietsch T. OS9.8 Genomic landscape of medulloblastoma in adults. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Medulloblastoma (MB) is a rare disease in adults. Therefore, only few cohorts have been studied so far.
METHODS
Histological features were evaluated and annotation of the tumors to WNT-MB, SHH-MB, and non-WNT/non-SHH-MB was performed by immunohistochemistry. Systematic analysis of tumor samples for genome-wide copy alterations was done by molecular inversion probe array. WNT- and SHH-activated MB were screened by NGS panel and Sanger sequencing for known MB-related genes.
RESULTS
The cohort of tumors from 117 patients contained 14.5% WNT-MB, 63.2% SHH-MB, and 22.2% non-WNT/non-SHH MB. Classic histology was found in WNT-MB, non-WNT/non-SHH-MB and 22% of SHH-MB; 78% of SHH-MB showed desmoplastic/nodular histology. In WNT-MB, CTNNB1 mutations were found in 88.2% and monosomy 6 in 52.9% of cases. In SHH-MB, PTCH1 mutations were present in 40% of cases and chromosome 9q loss including the PTCH1 locus was the most frequent copy number event in SHH-MB (50%), while SMO and SUFU mutations were found only in 15.4% resp. 7.7%. Mutations in the TERT promoter region were found in 92.3% of SHH-MBs. Only 2 (3%) of the SHH-MB were TP53-mutated (1.7% of the whole cohort). In non-WNT/non-SHH-MB, isochromosome 17q was the most frequent chromosomal alteration (84.6%). A previously published whole chromosomal aberration (WCA) signature with ≥1 WCA was found in 69.2% of cases. For 85 cases, survival data were available. WNT-MB presented no relapses (5-year OS: 100%), while SHH-MB with wildtype TP53 and non-WNT/non-SHH-MB showed similar outcomes (5-year OS: 78.1% and 69.1%, respectively). Both SHH-MB patients with mutant TP53 died of disease. Patients with non-WNT/non-SHH-MB characterized by the cytogenetic WCA phenotype showed - as described in pediatric standard-risk MB - significant better overall survival compared to patients with tumors lacking any WCA (p=0.01).
CONCLUSIONS
Adult MB represent four defined biological/genomic entities. In contrast to previously published data adult patients with WNT-MBs showed excellent survival. However, the number of patients with WNT-MB was limited so that this result has to be interpreted with caution. While in our cohort SHH-MB-TP53wt were standard risk independent of their mutational or chromosomal status, non-WNT/non-SHH-MB patients could be divided into two risk-groups according to the presence or absence of WCA in the tumors as previously published for childhood standard-risk MB by our group.
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Affiliation(s)
- T Goschzik
- University of Bonn Medical Center, Bonn, Germany
| | - A zur Mühlen
- University of Bonn Medical Center, Bonn, Germany
| | - E Dörner
- University of Bonn Medical Center, Bonn, Germany
| | - A Waha
- University of Bonn Medical Center, Bonn, Germany
| | - C Friedrich
- University Children’s Hospital Rostock, Rostock, Germany
| | - P Hau
- Regensburg University Hospital, Regensburg, Germany
| | - T Pietsch
- University of Bonn Medical Center, Bonn, Germany
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