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Green R, Ahmed A, Fleming B, Long AM, Behjati S, Trotman J, Tarpey P, Nicholson JC, Coleman N, Elizabeth Hook C, Murray MJ. Wilms Tumor With Raised Serum Alpha-Fetoprotein: Highlighting the Need for Novel Circulating Biomarkers. Pediatr Dev Pathol 2024; 27:260-265. [PMID: 38098239 PMCID: PMC11088205 DOI: 10.1177/10935266231213467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Wilms tumor (WT) is the commonest cause of renal cancer in children. In Europe, a diagnosis is made for most cases on typical clinical and radiological findings, prior to pre-operative chemotherapy. Here, we describe a case of a young boy presenting with a large abdominal tumor, associated with raised serum alpha-fetoprotein (AFP) levels at diagnosis. Given the atypical features present, a biopsy was taken, and histology was consistent with WT, showing triphasic WT, with epithelial, stromal, and blastemal elements present, and positive WT1 and CD56 immunohistochemical staining. During pre-operative chemotherapy, serial serum AFP measurements showed further increases, despite a radiological response, before a subsequent fall to normal following nephrectomy. The resection specimen was comprised of ~55% and ~45% stromal and epithelial elements, respectively, with no anaplasia, but immunohistochemistry using AFP staining revealed positive mucinous intestinal epithelium, consistent with the serum AFP observations. The lack of correlation between tumor response and serum AFP levels in this case highlights a more general clinical unmet need to identify WT-specific circulating tumor markers.
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Affiliation(s)
- Rebecca Green
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Adeeb Ahmed
- Department of Paediatrics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Ben Fleming
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anna-May Long
- Department of Paediatric Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sam Behjati
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - Jamie Trotman
- East Genomics Laboratory Hub (GLH) Genetics Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Patrick Tarpey
- East Genomics Laboratory Hub (GLH) Genetics Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James C. Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Paediatrics, Level 8, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nicholas Coleman
- Department of Paediatric Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - C. Elizabeth Hook
- Department of Paediatric Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Matthew J. Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Pathology, University of Cambridge, Cambridge, UK
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Bailey S, Ferraresso M, Alonso-Crisostomo L, Ward D, Smith S, Nicholson JC, Saini H, Enright AJ, Scarpini CG, Coleman N, Murray MJ. Targeting oncogenic microRNAs from the miR-371~373 and miR-302/367 clusters in malignant germ cell tumours causes growth inhibition through cell cycle disruption. Br J Cancer 2023; 129:1451-1461. [PMID: 37789102 PMCID: PMC10628203 DOI: 10.1038/s41416-023-02453-1] [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: 03/29/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND MiR-371~373 and miR-302/367 cluster over-expression occurs in all malignant germ cell tumours (GCTs), regardless of age (paediatric/adult), site (gonadal/extragonadal), or subtype [seminoma, yolk sac tumour (YST), embryonal carcinoma (EC)]. Six of eight microRNAs from these clusters contain the seed sequence 'AAGUGC', determining mRNA targeting. Here we sought to identify the significance of these observations by targeting these microRNAs functionally. METHODS We targeted miR-371~373 and/or miR-302/367 clusters in malignant GCT cell lines, using CRISPR-Cas9, gapmer primary miR-302/367 transcript inhibition, and peptide nucleic acid (PNA) or locked nucleic acid (LNA)-DNA inhibition targeting miR-302a-d-3p, and undertook relevant functional assays. RESULTS MiR-302/367 cluster microRNAs made the largest contribution to AAGUGC seed abundance in malignant GCT cells, regardless of subtype (seminoma/YST/EC). Following the unsuccessful use of CRISPR-Cas9, gapmer, and PNA systems, LNA-DNA-based targeting resulted in growth inhibition in seminoma and YST cells. This was associated with the de-repression of multiple mRNAs targeted by AAGUGC seed-containing microRNAs, with pathway analysis confirming predominant disruption of Rho-GTPase signalling, vesicle organisation/transport, and cell cycle regulation, findings corroborated in clinical samples. Further LNA-DNA inhibitor studies confirmed direct cell cycle effects, with an increase of cells in G0/G1-phase and a decrease in S-phase. CONCLUSION Targeting of specific miR-371~373 and miR-302/367 microRNAs in malignant GCTs demonstrated their functional significance, with growth inhibition mediated through cell cycle disruption.
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Affiliation(s)
- Shivani Bailey
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Marta Ferraresso
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | | | - Dawn Ward
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - Stephen Smith
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
- Department of Paediatrics, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Harpreet Saini
- EMBL-European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SD, UK
| | - Anton J Enright
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - Cinzia G Scarpini
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - Nicholas Coleman
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK.
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
| | - Matthew J Murray
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK.
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
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Bailey S, Ferraresso M, Alonso-Crisostomo L, Ward D, Smith S, Nicholson JC, Saini H, Enright AJ, Scarpini CG, Coleman N, Murray MJ. Correction: Targeting oncogenic microRNAs from the miR-371~373 and miR-302/367 clusters in malignant germ cell tumours causes growth inhibition through cell cycle disruption. Br J Cancer 2023; 129:1524. [PMID: 37919375 PMCID: PMC10628269 DOI: 10.1038/s41416-023-02479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Affiliation(s)
- Shivani Bailey
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Marta Ferraresso
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | | | - Dawn Ward
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - Stephen Smith
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
- Department of Paediatrics, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Harpreet Saini
- EMBL-European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SD, UK
| | - Anton J Enright
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - Cinzia G Scarpini
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - Nicholas Coleman
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK.
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
| | - Matthew J Murray
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK.
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
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Murray MJ, Hall NJ, Stoneham S, Penn A, Brougham M, Nicholson JC. Comment on: Standardizing the surgical management of benign ovarian tumors in children and adolescents: A best practice Delphi consensus statement. Pediatr Blood Cancer 2022; 69:e29690. [PMID: 35377549 DOI: 10.1002/pbc.29690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Pathology, University of Cambridge, Cambridge, UK
| | - Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sara Stoneham
- Department of Paediatrics and Child Health, University College Hospital London NHS Foundation Trust, London, UK
| | - Anthony Penn
- Department of Paediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - Mark Brougham
- Department of Paediatric Oncology, Royal Hospital for Children & Young People, Edinburgh, UK
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Laidlaw S, Alonso-Crisostomo L, Bailey S, Saini HK, Molnár A, Nicholson JC, Enright AJ, Scarpini CG, Rahbari R, Coleman N, Murray MJ, On Behalf Of The Children's Cancer And Leukaemia Group. Small non-coding RNA sequencing reveals global dysregulation of piwi-interacting RNA (piRNA) expression in gonadal malignant germ cell tumours. Andrology 2022; 11:738-755. [PMID: 36254403 DOI: 10.1111/andr.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Analyses of small non-coding RNA (ncRNA) expression in malignant germ cell tumours (GCTs) have focused on microRNAs (miRNAs). As GCTs all arise from primordial germ cells, and piwi-interacting RNAs (piRNAs) have important roles in maintaining germline integrity via transposon silencing, we hypothesised that malignant GCTs are characterised by fundamental piRNA dysregulation. AIMS We undertook global small ncRNA sequencing in malignant GCTs, in order to describe small ncRNA expression changes for both miRNAs and piRNAs. MATERIALS AND METHODS We performed small ncRNA next generation sequencing on a representative panel of 47 samples, comprising malignant GCT (n = 31) and control (n = 16) tissues/cell lines. Following quality control and normalisation, filtered count reads were used for differential miRNA and piRNA expression analyses via DESeq2. Predicted mRNA targets for piRNAs were identified and utilised for pathway enrichment analyses. RESULTS Overall, miRNAs and piRNAs comprised 21.9% and 43.0% of small ncRNA species, respectively. There were 749 differentially expressed miRNAs in malignant GCTs, of which 536 (72%) were over-expressed and 213 (28%) under-expressed. The top-ranking over-expressed miRNAs were exclusively from the miR-371∼373 and miR-302/367 clusters. The most significantly under-expressed miRNAs were miR-100-5p, miR-214-3p, miR-125b-5p, and let-7 family members, including miR-202-3p. There were 1,121 differentially expressed piRNAs in malignant GCTs, of which 167 (15%) were over-expressed and 954 (85%) under-expressed. Of note, of the top-20 differentially expressed piRNAs, 16 were over-expressed, of which piR-hsa-2506793 was both top-ranking and most abundant. Mobile element (ME; i.e., transposon) associated piRNAs comprised 166 (15%) of the 1,121 differentially expressed piRNAs, of which 165 (>99%) were downregulated. The remaining 955 (85%) non-ME-associated piRNAs may have wider cellular roles. To explore this, predicted mRNA targets of differentially expressed piRNAs identified putative involvement in cancer-associated pathways. CONCLUSION This study confirms previous miRNA observations, giving credence to our novel demonstration of global piRNA dysregulation in gonadal malignant GCTs, through both ME and non-ME associated pathways, which likely contributes to GCT pathogenesis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sean Laidlaw
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | | | - Shivani Bailey
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - Harpreet K Saini
- EMBL-European Bioinformatics Institute, Hinxton, Cambridge, CB10 1SD, UK
| | - Attila Molnár
- Department of Plant Sciences, University of Cambridge, Cambridge, CB2 3EA, UK
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.,Department of Paediatrics, University of Cambridge, Level 8, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Anton J Enright
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - Cinzia G Scarpini
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - Raheleh Rahbari
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Nicholas Coleman
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK.,Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Matthew J Murray
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK.,Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
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Shabo E, Czech T, Nicholson JC, Mallucci C, Mottolese C, Piatelli G, Frappaz D, Murray MJ, Faure-Conter C, Garrè ML, Sarikaya-Seiwert S, Weinhold L, Haberl H, Calaminus G. Evaluation of the Perioperative and Postoperative Course of Surgery for Pineal Germinoma in the SIOP CNS GCT 96 Trial. Cancers (Basel) 2022; 14:cancers14143555. [PMID: 35884617 PMCID: PMC9323477 DOI: 10.3390/cancers14143555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background: CNS germinoma, being marker-negative, are mainly diagnosed by histological examination. These tumors predominantly appear in the suprasellar and/or pineal region. In contrast to the suprasellar region, where biopsy is the standard procedure in case of a suspected germ-cell tumor to avoid mutilation to the endocrine structures, pineal tumors are more accessible to primary resection. We evaluated the perioperative course of patients with pineal germinoma who were diagnosed by primary biopsy or resection in the SIOP CNS GCT 96 trial. Methods: Overall, 235 patients had germinoma, with pineal localization in 113. The relationship between initial symptoms, tumor size, and postoperative complications was analyzed. Results: Of 111 evaluable patients, initial symptoms were headache (n = 98), hydrocephalus (n = 93), double vision (n = 62), Parinaud syndrome (n = 57), and papilledema (n = 44). There was no significant relationship between tumor size and primary symptoms. A total of 57 patients underwent primary resection and 54 underwent biopsy. Postoperative complications were reported in 43.2% of patients after resection and in 11.4% after biopsy (p < 0.008). Biopsy was significantly more commonly performed on larger tumors (p= 0.002). Conclusions: These results support the practice of biopsy over resection for histological confirmation of pineal germinoma.
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Affiliation(s)
- Ehab Shabo
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
- Correspondence: ; Tel.: +49-228-287-16521; Fax: +49-228-287-11366
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - James C. Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children’s Hospital, Liverpool L14 5AB, UK; (C.M.); (M.J.M.)
| | - Carmine Mottolese
- Neurochirurgie Pédiatrique, Hôpital Femme-Mère-Enfant, Université de Lyon, 59, Boulevard Pinel, 69003 Lyon, France;
| | - Gianluca Piatelli
- Division of Neurosurgery, Department of Neurosciences, Giannina Gaslini Children’s Hospital, 16147 Genvoa, Italy;
| | - Didier Frappaz
- Department of Pediatric Hematology and Oncology, Institut d’Hématologie et d’Oncologie Pédiatrique, 69008 Lyon, France; (D.F.); (C.F.-C.)
| | - Matthew Jonathan Murray
- Department of Neurosurgery, Alder Hey Children’s Hospital, Liverpool L14 5AB, UK; (C.M.); (M.J.M.)
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK
| | - Cecile Faure-Conter
- Department of Pediatric Hematology and Oncology, Institut d’Hématologie et d’Oncologie Pédiatrique, 69008 Lyon, France; (D.F.); (C.F.-C.)
| | - Maria Luisa Garrè
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Sevgi Sarikaya-Seiwert
- Section of Pediatric Neurosurgery, Department of Neurosurgery, Rheinische, Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127 Bonn, Germany; (S.S.-S.); (H.H.)
| | - Leonie Weinhold
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Hannes Haberl
- Section of Pediatric Neurosurgery, Department of Neurosurgery, Rheinische, Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127 Bonn, Germany; (S.S.-S.); (H.H.)
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
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Trotman J, Armstrong R, Firth H, Trayers C, Watkins J, Allinson K, Jacques TS, Nicholson JC, Burke GAA, Behjati S, Murray MJ, Hook CE, Tarpey P. The NHS England 100,000 Genomes Project: feasibility and utility of centralised genome sequencing for children with cancer. Br J Cancer 2022; 127:137-144. [PMID: 35449451 PMCID: PMC9276782 DOI: 10.1038/s41416-022-01788-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/13/2022] [Accepted: 03/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Whole-genome sequencing (WGS) of cancers is becoming an accepted component of oncological care, and NHS England is currently rolling out WGS for all children with cancer. This approach was piloted during the 100,000 genomes (100 K) project. Here we share the experience of the East of England Genomic Medicine Centre (East-GMC), reporting the feasibility and clinical utility of centralised WGS for individual children locally. METHODS Non-consecutive children with solid tumours were recruited into the pilot 100 K project at our Genomic Medicine Centre. Variant catalogues were returned for local scrutiny and appraisal at dedicated genomic tumour advisory boards with an emphasis on a detailed exploration of potential clinical value. RESULTS Thirty-six children, representing one-sixth of the national 100 K cohort, were recruited through our Genomic Medicine Centre. The diagnoses encompassed 23 different solid tumour types and WGS provided clinical utility, beyond standard-of-care assays, by refining (2/36) or changing (4/36) diagnoses, providing prognostic information (8/36), defining pathogenic germline mutations (1/36) or revealing novel therapeutic opportunities (8/36). CONCLUSION Our findings demonstrate the feasibility and clinical value of centralised WGS for children with cancer. WGS offered additional clinical value, especially in diagnostic terms. However, our experience highlights the need for local expertise in scrutinising and clinically interpreting centrally derived variant calls for individual children.
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Affiliation(s)
- Jamie Trotman
- East-Genomics Laboratory Hub (GLH) Genetics Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Ruth Armstrong
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Helen Firth
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Claire Trayers
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - James Watkins
- East-Genomics Laboratory Hub (GLH) Genetics Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Kieren Allinson
- Department of Neuropathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Department, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - G A Amos Burke
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | | | - Sam Behjati
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK.
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
| | - Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK.
| | - Catherine E Hook
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK.
| | - Patrick Tarpey
- East-Genomics Laboratory Hub (GLH) Genetics Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
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Morana G, Shaw D, MacDonald SM, Alapetite C, Ajithkumar T, Bhatia A, Brisse H, Jaimes C, Czech T, Dhall G, Fangusaro J, Faure-Conter C, Fouladi M, Hargrave D, Harreld JH, Mitra D, Nicholson JC, Souweidane M, Timmermann B, Calaminus G, Bartels U, Bison B, Murray MJ. Imaging response assessment for CNS germ cell tumours: consensus recommendations from the European Society for Paediatric Oncology Brain Tumour Group and North American Children's Oncology Group. Lancet Oncol 2022; 23:e218-e228. [PMID: 35489353 DOI: 10.1016/s1470-2045(22)00063-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
Homogeneous and common objective disease assessments and standardised response criteria are important for better international clinical trials for CNS germ cell tumours. Currently, European protocols differ from those of North America (the USA and Canada) in terms of criteria to assess radiological disease response. An international working group of the European Society for Paediatric Oncology Brain Tumour Group and North American Children's Oncology Group was therefore established to review existing literature and current practices, identify major challenges regarding imaging assessment, and develop consensus recommendations for imaging response assessment for patients with CNS germ cell tumours. New clinical imaging standards were defined for the most common sites of CNS germ cell tumour and for the definition of locoregional extension. These new standards will allow the evaluation of response to therapy in patients with CNS germ cell tumours to be more consistent, and facilitate direct comparison of treatment outcomes across international studies.
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Affiliation(s)
- Giovanni Morana
- Department of Neurosciences, Neuroradiology Unit, University of Turin, Turin, Italy
| | - Dennis Shaw
- Department of Radiology, Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Claire Alapetite
- Department of Radiation Oncology and Proton Center, Institut Curie, Paris, France
| | - Thankamma Ajithkumar
- Department of Radiation Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Aashim Bhatia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hervé Brisse
- Department of Imaging, Institut Curie, Paris, France
| | - Camilo Jaimes
- Department of Radiology, Boston Children's Hospital and Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Girish Dhall
- Division of Pediatric Hematology and Oncology, Department of Pediatrics School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason Fangusaro
- Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Maryam Fouladi
- Department of Pediatric Hematology and Oncology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Darren Hargrave
- Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Julie H Harreld
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Dipayan Mitra
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mark Souweidane
- Department of Neurosurgery, NewYork-Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital, Essen, Germany; West German Proton Therapy Centre, Essen, Germany; West German Cancer Center, Essen, Germany
| | - Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Ute Bartels
- Pediatric Brain Tumour Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Pathology, University of Cambridge, Cambridge, UK.
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Fonseca A, Faure-Conter C, Murray MJ, Fangusaro J, Bailey S, Goldman S, Khatua S, Frappaz D, Calaminus G, Dhall G, Nicholson JC, Bouffet E, Bartels U. Pattern of treatment failures in patients with central nervous system non-germinomatous germ cell tumors (CNS-NGGCT): A pooled analysis of clinical trials. Neuro Oncol 2022; 24:1950-1961. [PMID: 35218656 PMCID: PMC9629424 DOI: 10.1093/neuonc/noac057] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Central Nervous System Non-Germinomatous Germ Cell Tumors (CNS-NGGCT) are rare but curable tumors. Due to their rarity, patients with treatment failures remain a poorly characterized group with unfavorable outcomes. In this study, we sought to characterize patients with treatment failures in a large, prospectively treated cohort. METHODS European and North American clinical trials for patients with CNS-NGGCT (SIOP-GCT-96, SFOP-TGM-TC 90/92, COG-ACNS0122, and COG-ACNS1123) were pooled for analysis. Additionally, patients included and treated in the UK and France national registries under strict protocol guidelines were included as an independent, non-overlapping cohort. RESULTS A total of 118 patients experienced a treatment failure. Twenty-four patients had progressive disease during therapy, and additional 11 patients were diagnosed with growing teratoma syndrome (GTS). Patients with GTS are significantly younger and present with local failures and negative tumor markers. Eighty-three individuals experienced disease relapses after treatment ended. Patients' metastatic relapses presented significantly earlier than local relapses and were associated with tumor marker elevation (OR: 4.39; P = .026). In our analysis, focal or whole-ventricular radiation therapy was not associated with an increased risk of metastatic relapses. CONCLUSIONS Herein, we present the largest pooled dataset of prospectively treated patients with relapsed CNS-NGGCT. Our study identified younger age and negative tumor markers to be characteristic of GTS. Additionally, we elucidated that metastatic relapses occur earlier than local relapses are associated with elevated tumor markers and are not associated with the field of radiation therapy. These findings are of utmost importance for the planning of future clinical trials and the implementation of surveillance strategies in these patients.
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Affiliation(s)
- Adriana Fonseca
- Corresponding Author: Adriana Fonseca, MD, Department of Oncology, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA ()
| | - Cecile Faure-Conter
- Department of Pediatrics, Institut d’Hemato-Oncologie Pediatrique, Lyon, France
| | - Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,Department of Pathology, University of Cambridge, Cambridge, UK
| | - Jason Fangusaro
- Aflac Cancer Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shivani Bailey
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stewart Goldman
- Phoenix Children’s Hospital, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Soumen Khatua
- Department of Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Didier Frappaz
- Department of Pediatrics, Institut d’Hemato-Oncologie Pediatrique, Lyon, France
| | - Gabriele Calaminus
- Department of Pediatric Hematology/Oncology, University Children’s Hospital Bonn, Bonn, Germany
| | - Girish Dhall
- Department of Pediatric Hematology Oncology, O’Neal Comprehensive Cancer Center at University of Alabama, Birmingham, Alabama, USA
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Eric Bouffet
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ute Bartels
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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10
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Murray MJ, Moleron R, Adamski J, English M, Burke GAA, Cross J, Ajithkumar T, Stoneham S, Nicholson JC. Vinblastine monotherapy induction prior to radiotherapy for patients with intracranial germinoma during the COVID-19 pandemic. Pediatr Blood Cancer 2022; 69:e29359. [PMID: 34520101 PMCID: PMC8662027 DOI: 10.1002/pbc.29359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with localized intracranial germinoma have excellent survival. Reducing treatment burden and long-term sequelae is a priority. Intensive inpatient chemotherapy (e.g., carboPEI = carboplatin/etoposide/ifosfamide) has been effectively employed to reduce radiotherapy treatment volume/dose. Outpatient-based carboplatin monotherapy is associated with excellent outcomes in metastatic testicular seminoma (an identical pathology), and successful vinblastine monotherapy induction (with 77% tumor volume reduction after just two weekly vinblastine doses) has recently been reported in an intracranial germinoma patient. METHODS Adapted UK guidelines for germ cell tumor management were distributed during the COVID-19 pandemic, including nonstandard treatment options to reduce hospital visits and/or admissions. This included vinblastine monotherapy for intracranial germinoma (6 mg/m2 intravenously, or 4 mg/m2 for moderate count suppression, delivered weekly). We describe two such patients treated using this approach. RESULTS A 30-year-old male with a localized pineal tumor received 12-week vinblastine induction, with >60% volume reduction, prior to definitive radiotherapy. A 12-year-old female with a metastatic suprasellar tumor and progression at all sites of disease whilst awaiting proton radiotherapy received two vinblastine doses with good early response, including 36% primary tumor volume reduction. The patients tolerated vinblastine well. CONCLUSION Patients with intracranial germinoma have excellent outcomes, and reduction of late effects remains a priority. The description of vinblastine monotherapy in these intracranial germinoma patients warrants further exploration.
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Affiliation(s)
- Matthew J. Murray
- Department of PathologyUniversity of CambridgeCambridgeUK,Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Rafael Moleron
- Department of Clinical OncologyAberdeen Royal InfirmaryAberdeenUK
| | - Jennifer Adamski
- Department of Paediatric Haematology and OncologyBirmingham Children's HospitalBirminghamUK
| | - Martin English
- Department of Paediatric Haematology and OncologyBirmingham Children's HospitalBirminghamUK
| | - G. A. Amos Burke
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Justin Cross
- Department of RadiologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Thankamma Ajithkumar
- Department of OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Sara Stoneham
- Department of Paediatric and TYA OncologyUniversity College Hospital LondonLondonUK
| | - James C. Nicholson
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
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11
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Frappaz D, Dhall G, Murray MJ, Goldman S, Faure Conter C, Allen J, Kortmann R, Haas-Kogen D, Morana G, Finlay J, Nicholson JC, Bartels U, Souweidane M, Schöenberger S, Vasiljevic A, Robertson P, Albanese A, Alapetite C, Czech T, Lau CC, Wen P, Schiff D, Shaw D, Calaminus G, Bouffet E. Intracranial germ cell tumors in Adolescents and Young Adults: European and North American consensus review, current management and future development. Neuro Oncol 2021; 24:516-527. [PMID: 34724065 PMCID: PMC8972311 DOI: 10.1093/neuonc/noab252] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The incidence of intracranial germ cell tumors (iGCT) is much lower in European and North American (E&NA) than in Asian population. However, E&NA cooperative groups have simultaneously developed with success treatment strategies with specific attention paid to long-term sequelae. Neurological sequelae may be reduced by establishing a diagnosis with an endoscopic biopsy and/or cerebrospinal fluid (CSF) and/or serum analysis, deferring the need to perform a radical surgery. Depending on markers and/or histological characteristics, patients are treated as either germinoma or non-germinomatous germ cell tumors (NGGCT). Metastatic disease is defined by a positive CSF cytology and/or distant drops in craniospinal MRI. The combination of surgery and/or chemotherapy and radiation therapy is tailored according to grouping and staging. With more than 90% 5-year event-free survival (EFS), localized germinomas can be managed without aggressive surgery, and benefit from chemotherapy followed by whole ventricular irradiation with local boost. Bifocal germinomas are treated as non-metastatic entities. Metastatic germinomas may be cured with craniospinal irradiation. With a 5-year EFS over 70%, NGGCT benefit from chemotherapy followed by delayed surgery in case of residual disease, and some form of radiotherapy. Future strategies will aim at decreasing long-term side effects while preserving high cure rates.
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Affiliation(s)
- D Frappaz
- Institut d'Hématologie Oncologie Pédiatrique, Lyon, France
| | - G Dhall
- University of Alabama at Birmingham (UAB), Birmingham, USA
| | - M J Murray
- Department of Pathology, University of Cambridge, Cambridge, UK.,Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Goldman
- Phoenix Children's Hospital University of Arizona, USA
| | - C Faure Conter
- Institut d'Hématologie Oncologie Pédiatrique, Lyon, France
| | - J Allen
- NYU Grossman School, New York, USA
| | - R Kortmann
- University of Leipzig Medical Center; Leipzig, Germany
| | | | | | - J Finlay
- Nationwide Children's Hospital, Colombus, USA
| | - J C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ute Bartels
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M Souweidane
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - S Schöenberger
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - A Vasiljevic
- Centre de Pathologie et Neuropathologie Est, Hospices Civils de Lyon, France
| | | | | | | | - T Czech
- Medical University of Vienna, Austria
| | - C C Lau
- Connecticut Children's Medical Center, USA
| | - P Wen
- University of Leipzig Medical Center; Leipzig, Germany
| | - D Schiff
- University of Virginia School of Medicine, Charlottesville, USA
| | - D Shaw
- Seattle Children's Hospital and University of Washington, Seattle USA
| | | | - E Bouffet
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
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12
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Calaminus G, Frappaz D, Kortmann RD, Ajithkumar T, Pietsch T, Vasiljevic A, Ricardi U, Faure-Conter C, Timmermann B, Alapetite C, Murray MJ, Garre ML, Nicholson JC. GCT-48. OUTCOME OF CNS MALIGNANT NON-GERMINOMATOUS GERM CELL TUMORS (GCT) WITH AFP > 1000 ng/ml AT DIAGNOSIS TREATED ACCORDING TO SIOP CNS GCT 96. Neuro Oncol 2020. [PMCID: PMC7715920 DOI: 10.1093/neuonc/noaa222.266] [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
Analysis of CNS MMGCT with AFP >1000 ng/ml (serum and/or CSF) at diagnosis, treated on trial in SIOP-CNS-GCT-96, revealed an inferior prognosis (32% 5-year progression-free survival) compared with AFP <1000 ng/ml (76%). As this patient group is small, to evaluate a bigger cohort, we revisited all patients treated according to SIOP-CNS-GCT-96, who were registered in the database until July 2015. Between October 1996 and July 2015, 373 patients with CNS MMGCT were registered. 48 patients (13%) presented with an AFP >1000 ng/ml at diagnosis. 41 patients were evaluable with a median observation time of 2.4 years; 6/41 received chemotherapy alone. Primary site, histological components (if available), metastatic status and outcome were evaluated. Primary site was pineal in 29/41, suprasellar in 6/41, bifocal 1/41 and other in 5/41 patients. 10/41 patients were metastatic at diagnosis. Four to five courses of standard PEI and radiotherapy (RT) or 2 standard and two intensified PEI (as for SIOP CNS GCT II) were administered in 32 patients. Two received less then 4x PEI and RT, 6 patients <6 years were treated with PEI (either standard or intensified) alone. 16/34 patients with PEI and RT are alive in CR; 2/6 patients without RT survived. Overall, 18/40 (45%) survived. 10–15% of CNS MGGCT are high-risk patients by diagnostic AFP, with the pineal as the main tumour site. Outcome of <50% survival is unsatisfactory. Further research, international cooperation and common data analysis is needed to identify additional risk factors and develop alternative treatment strategies.
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Affiliation(s)
- Gabriele Calaminus
- Department of Paediatric Haematology and Oncology University Hospital, Bonn, Germany
| | - Didier Frappaz
- Department of Paediatric Haematology and Oncology, Institute of Paediatric Haematology and Oncology (IHOPe), Lyon, France
| | - Rolf-Dieter Kortmann
- Department of Radiotherapy and Radiooncology, University Hospital, Leipzig, Germany
- Department of Radiotherapy and Radiooncology, University Hospital, Cambridge, United Kingdom
| | - Thankamma Ajithkumar
- Department of Radiotherapy and Radiooncology, University Hospital, Cambridge, United Kingdom
| | - Torsten Pietsch
- , Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Alexandre Vasiljevic
- Department of Biopathology, Institut Multisite de Pathologie, Hospices Civiles, Lyon, France
| | | | - Cecile Faure-Conter
- Department of Paediatric Haematology and Oncology, Institute of Paediatric Haematology and Oncology (IHOPe), Lyon, France
| | - Beate Timmermann
- Department of Radiation Oncology, Clinic of Proton Therapy, Essen, Germany
| | - Claire Alapetite
- Department of Radiation Oncology, Curie Institute, Paris, France
| | - Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Maria Luisa Garre
- Department of Paediatric Haematology and Oncology, Gaslini Childrens Hospital, Genova, Italy
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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13
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Shaikh F, Stark D, Fonseca A, Dang H, Xia C, Krailo M, Pashankar F, Rodriguez-Galindo C, Olson TA, Nicholson JC, Murray MJ, Amatruda JF, Billmire D, Stoneham S, Frazier AL. Outcomes of adolescent males with extracranial metastatic germ cell tumors: A report from the Malignant Germ Cell Tumor International Consortium. Cancer 2020; 127:193-202. [PMID: 33079404 DOI: 10.1002/cncr.33273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/13/2020] [Accepted: 09/21/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adolescents with extracranial metastatic germ cell tumors (GCTs) are often treated with regimens developed for children, but their clinical characteristics more closely resemble those of young adult patients. This study was designed to determine event-free survival (EFS) for adolescents with GCTs and compared them with children and young adults. METHODS An individual patient database of 11 GCT trials was assembled: 8 conducted by pediatric cooperative groups and 3 conducted by an adult group. Male patients aged 0 to 30 years with metastatic, nonseminomatous, malignant GCTs of the testis, retroperitoneum, or mediastinum who were treated with platinum-based chemotherapy were included. The age groups were categorized as children (0 to <11 years), adolescents (11 to <18 years), and young adults (18 to ≤30 years). The study compared EFS and adjusted for risk group by using Cox proportional hazards analysis. RESULTS From a total of 2024 individual records, 593 patients met the inclusion criteria: 90 were children, 109 were adolescents, and 394 were young adults. The 5-year EFS rate was lower for adolescents (72%; 95% confidence interval [CI], 62%-79%) than children (90%; 95% CI, 81%-95%; P = .003) or young adults (88%; 95% CI, 84%-91%; P = .0002). The International Germ Cell Cancer Collaborative Group risk group was associated with EFS in the adolescent age group (P = .0020). After adjustments for risk group, the difference in EFS between adolescents and children remained significant (hazard ratio, 0.30; P = .001). CONCLUSIONS EFS for adolescent patients with metastatic GCTs was similar to that for young adults but significantly worse than for that children. This finding highlights the importance of coordinating initiatives across clinical trial organizations to improve outcomes for adolescents and young adults. LAY SUMMARY Adolescent males with metastatic germ cell tumors (GCTs) are frequently treated with regimens developed for children. In this study, a large data set of male patients with metastatic GCTs across different age groups has been built to understand the outcomes of adolescent patients in comparison with children and young adults. The results suggest that adolescent males with metastatic GCTs have worse results than children and are more similar to young adults with GCTs. Therefore, the treatment of adolescents with GCTs should resemble therapeutic approaches for young adults.
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Affiliation(s)
- Furqan Shaikh
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Stark
- Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - Adriana Fonseca
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ha Dang
- Children's Oncology Group, Monrovia, California
| | - Caihong Xia
- Children's Oncology Group, Monrovia, California
| | - Mark Krailo
- Children's Oncology Group, Monrovia, California
| | | | | | - Thomas A Olson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - James C Nicholson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Matthew J Murray
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James F Amatruda
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | | | - Sara Stoneham
- Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom
| | - A Lindsay Frazier
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
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14
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Murray MJ, Ajithkumar T, Harris F, Williams RM, Jalloh I, Cross J, Ronghe M, Ward D, Scarpini CG, Nicholson JC, Coleman N. Clinical utility of circulating miR-371a-3p for the management of patients with intracranial malignant germ cell tumors. Neurooncol Adv 2020; 2:vdaa048. [PMID: 32642701 PMCID: PMC7236383 DOI: 10.1093/noajnl/vdaa048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The current biomarkers alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) have limited sensitivity/specificity for diagnosing malignant germ cell tumors (GCTs) and "marker-negative" patients require histological confirmation for diagnosis. However, GCTs at intracranial sites are surgically relatively inaccessible and biopsy carries risks. MicroRNAs from the miR-371~373 and miR-302/367 clusters are over-expressed in all malignant GCTs and, in particular, miR-371a-3p shows elevated serum levels at diagnosis for testicular disease. Methods Using our robust preamplified qRT-PCR methodology, we quantified miR-371a-3p levels in serum and cerebrospinal fluid (CSF) in a series of 4 representative clinical cases, 3 with intracranial malignant GCT and 1 with Langerhans cell histiocytosis (LCH), compared with appropriate control cases. Results Serum and/or CSF miR-371a-3p levels distinguished those with intracranial malignant GCTs from LCH and, if known in real time, could have helped clinical management. The benefits would have included (1) the only confirmatory evidence of an intracranial malignant GCT in 1 case, supporting clinical decision making; (2) early detection of intracranial malignant GCT in another, where an elevated CSF miR-371a-3p level preceded the histologically confirmed diagnosis by 2 years; and (3) confirmation of an intracranial malignant GCT relapse with an elevated serum miR-371a-3p level, where serum and CSF AFP and HCG levels were below thresholds for such a diagnosis. Conclusions This series highlights the potential for microRNA quantification to assist the noninvasive diagnosis, prognostication, and management for patients with intracranial malignant GCTs. Serum and CSF should be collected routinely as part of future studies to facilitate the extension of these findings to larger patient cohorts.
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Affiliation(s)
- Matthew J Murray
- Department of Pathology, University of Cambridge, Cambridge, UK.,Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thankamma Ajithkumar
- Department of Medical Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fiona Harris
- Department of Medical Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rachel M Williams
- Department of Paediatric Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ibrahim Jalloh
- Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Justin Cross
- Department of Neuroradiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Milind Ronghe
- Department of Paediatric Haematology and Oncology, Royal Hospital for Children, Glasgow, UK
| | - Dawn Ward
- Department of Pathology, University of Cambridge, Cambridge, UK
| | | | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nicholas Coleman
- Department of Pathology, University of Cambridge, Cambridge, UK.,Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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15
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Coorens THH, Treger TD, Al-Saadi R, Moore L, Tran MGB, Mitchell TJ, Tugnait S, Thevanesan C, Young MD, Oliver TRW, Oostveen M, Collord G, Tarpey PS, Cagan A, Hooks Y, Brougham M, Reynolds BC, Barone G, Anderson J, Jorgensen M, Burke GAA, Visser J, Nicholson JC, Smeulders N, Mushtaq I, Stewart GD, Campbell PJ, Wedge DC, Martincorena I, Rampling D, Hook L, Warren AY, Coleman N, Chowdhury T, Sebire N, Drost J, Saeb-Parsy K, Stratton MR, Straathof K, Pritchard-Jones K, Behjati S. Embryonal precursors of Wilms tumor. Science 2019; 366:1247-1251. [PMID: 31806814 PMCID: PMC6914378 DOI: 10.1126/science.aax1323] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/04/2019] [Accepted: 11/06/2019] [Indexed: 12/27/2022]
Abstract
Adult cancers often arise from premalignant clonal expansions. Whether the same is true of childhood tumors has been unclear. To investigate whether Wilms tumor (nephroblastoma; a childhood kidney cancer) develops from a premalignant background, we examined the phylogenetic relationship between tumors and corresponding normal tissues. In 14 of 23 cases studied (61%), we found premalignant clonal expansions in morphologically normal kidney tissues that preceded tumor development. These clonal expansions were defined by somatic mutations shared between tumor and normal tissues but absent from blood cells. We also found hypermethylation of the H19 locus, a known driver of Wilms tumor development, in 58% of the expansions. Phylogenetic analyses of bilateral tumors indicated that clonal expansions can evolve before the divergence of left and right kidney primordia. These findings reveal embryonal precursors from which unilateral and multifocal cancers develop.
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Affiliation(s)
| | - Taryn D Treger
- Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Reem Al-Saadi
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Luiza Moore
- Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Maxine G B Tran
- UCL Division of Surgery and Interventional Science, Royal Free Hospital, London NW3 2PS, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London NW3 2PS, UK
| | - Thomas J Mitchell
- Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Suzanne Tugnait
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | | | | | - Thomas R W Oliver
- Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK
| | - Minou Oostveen
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Grace Collord
- Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Patrick S Tarpey
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Alex Cagan
- Wellcome Sanger Institute, Hinxton CB10 1SA, UK
| | | | - Mark Brougham
- Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK
| | - Ben C Reynolds
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Giuseppe Barone
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - John Anderson
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Mette Jorgensen
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - G A Amos Burke
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Johannes Visser
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - James C Nicholson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Naima Smeulders
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Imran Mushtaq
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Grant D Stewart
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | | | - David C Wedge
- Big Data Institute, University of Oxford, Oxford OX3 7LF, UK
- Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | | | - Dyanne Rampling
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Liz Hook
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK
| | - Anne Y Warren
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK
| | - Nicholas Coleman
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK
| | - Tanzina Chowdhury
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Neil Sebire
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Jarno Drost
- Princess Máxima Center for Pediatric Oncology, Oncode Institute, 3584 CS Utrecht, Netherlands
| | - Kourosh Saeb-Parsy
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | | | - Karin Straathof
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Sam Behjati
- Wellcome Sanger Institute, Hinxton CB10 1SA, UK.
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
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Affiliation(s)
| | | | - Angela Polanco
- National Cancer Research Institute Childhood Cancer and Leukaemia Clinical Studies Group, London, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
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Calaminus G, Frappaz D, Kortmann RD, Krefeld B, Saran F, Pietsch T, Vasiljevic A, Garre ML, Ricardi U, Mann JR, Göbel U, Alapetite C, Murray MJ, Nicholson JC. Outcome of patients with intracranial non-germinomatous germ cell tumors-lessons from the SIOP-CNS-GCT-96 trial. Neuro Oncol 2018; 19:1661-1672. [PMID: 29048505 DOI: 10.1093/neuonc/nox122] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Following promising results to increase survival and reduce treatment burden in intracranial non-germinomatous germ cell tumors (NGGCTs), we conducted a European study using dose-intense chemotherapy followed by risk-adapted radiotherapy. Methods All patients received 4 courses of cisplatin/etoposide/ifosfamide. Non-metastatic patients then received focal radiotherapy only (54 Gy); metastatic patients received 30 Gy craniospinal radiotherapy with 24 Gy boost to primary tumor and macroscopic metastatic sites. Results Patients with localized malignant NGGCT (n = 116) demonstrated 5-year progression-free survival (PFS) and overall survival (OS) of 0.72 ± 0.04 and 0.82 ± 0.04, respectively. Primary tumor sites were: 67 pineal, 35 suprasellar, 5 bifocal, 9 others. One patient died postsurgery in clinical remission; 3 patients progressed during treatment and 27 (23%) relapsed afterward. Fourteen were local, 6 combined, and 7 distant relapses (outside radiation field). Seventeen of the 27 relapsed patients died of disease. Patients with metastatic disease (n = 33) demonstrated 5-year PFS and OS of 0.68 ± 0.09 and 0.75 ± 0.08, respectively; 1 patient died following progression on treatment and 9 (27%) relapsed afterward (5 local, 1 combined, 3 distant). Only one metastatic patient with recurrence was salvaged. Multivariate analysis identified diagnostic alpha-fetoprotein level (serum and/or cerebrospinal fluid level >1000 ng/mL, 19/149 patients, of whom 11 relapsed; P < 0.0003) and residual disease following treatment, including after second-look surgery (n = 52/145 evaluable patients, 26 relapsed; P = 0.0002) as significant prognostic indicators in this cohort. Conclusion In localized malignant NGGCT, craniospinal radiotherapy could be avoided without increased relapses outside the radiotherapy field. Chemotherapy and craniospinal radiotherapy remain the gold standard for metastatic disease.
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Affiliation(s)
- Gabriele Calaminus
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Didier Frappaz
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Rolf Dieter Kortmann
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Barbara Krefeld
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Frank Saran
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Torsten Pietsch
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Alexandre Vasiljevic
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Maria Luisa Garre
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Umberto Ricardi
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Jillian R Mann
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Ulrich Göbel
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Claire Alapetite
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Matthew J Murray
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - James C Nicholson
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
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Frazier AL, Stoneham S, Rodriguez-Galindo C, Dang H, Xia C, Olson TA, Murray MJ, Amatruda JF, Shaikh F, Pashankar F, Billmire D, Krailo M, Stark D, Brougham MFH, Nicholson JC, Hale JP. Comparison of carboplatin versus cisplatin in the treatment of paediatric extracranial malignant germ cell tumours: A report of the Malignant Germ Cell International Consortium. Eur J Cancer 2018; 98:30-37. [PMID: 29859339 DOI: 10.1016/j.ejca.2018.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 12/15/2017] [Revised: 02/22/2018] [Accepted: 03/07/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE To compare the outcomes of paediatric and adolescent extracranial malignant germ cell tumour (GCT) patients treated with either carboplatin or cisplatin on clinical trials conducted by the Children's Oncology Group (COG) and the Children's Cancer and Leukaemia Group (CCLG). METHODS The Malignant Germ Cell International Consortium (MaGIC) has created a database of the GCT clinical trials conducted since 1983 by COG (United States, Canada and Australia), which used cisplatin-based regimens, and by CCLG (United Kingdom), which used carboplatin-based regimens. Using the parametric cure model, this study compared the overall 4-year event-free survival (EFS), stratified by age, stage, site and the a-priori defined MaGIC 'risk' groups: standard risk ((SR) 1 (EFS >80%; age <11 years), SR2 (EFS >80%, age ≥ 11y) and poor risk (PR) (EFS ≤ 70%, age ≥ 11y). RESULTS Cisplatin-based therapy was used in 620 patients; carboplatin was used in 163 patients. In the overall multivariate cure model, the two regimens did not differ significantly (cisplatin: 4-year EFS 86%; 95% confidence interval (CI) 83-89% versus carboplatin 4-year EFS 86%; 95% CI 79-90%; p = 0.87). No significant differences were noted in stratified analyses by site, stage, age and MaGIC risk groups: SR1 (p = 0.20), SR2 (p = 0.55) or PR (p = 0.72) patients. CONCLUSIONS In these trials conducted contemporaneously, there is no significant difference in outcome observed overall, or any subset of patients, who were treated with regimens containing cisplatin versus carboplatin These results suggested sufficient equipoise to justify a randomised trial to evaluate the effectiveness of carboplatin versus cisplatin in the treatment of children, adolescents and young adults with standard risk GCT, which is currently underway.
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Affiliation(s)
- A Lindsay Frazier
- Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Sara Stoneham
- University College London Hospital Trusts, 235 Euston Road, London, NW1 2BU, UK
| | | | - Ha Dang
- Children's Oncology Group, 222 East Huntington Drive, Monrovia, CA, 91016, USA; Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Caihong Xia
- Children's Oncology Group, 222 East Huntington Drive, Monrovia, CA, 91016, USA
| | - Thomas A Olson
- Children's Healthcare of Atlanta, Emory University, 1405 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Matthew J Murray
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK; Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - James F Amatruda
- University of Texas Southwestern Medical Center and Children's Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Furqan Shaikh
- Hospital for Sick Children, Haematology/Oncology, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Farzana Pashankar
- Yale University School of Medicine, LMP 2073, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Deborah Billmire
- Riley Hospital for Children, 705 Riley Hospital Drive Indianapolis, IN, 46202, USA
| | - Mark Krailo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Dan Stark
- St James's Institute of Oncology, St. James University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Mark F H Brougham
- Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF, UK
| | - James C Nicholson
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Juliet P Hale
- Department of Paediatric Haematology and Oncology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle Upon Tyne, Tyne and Wear, NE1 4LP, UK
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19
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Kuhrt CA, Kortmann RD, Frappaz D, Saran F, Garre ML, Müller JE, Ricardi U, Czech T, Alapetite C, Nicholson JC, Calaminus G. GERM-12. PITUITARY FAILURES IN CNS MIXED MALIGNANT GERM CELL TUMORS (MMGCTs). EXPERIENCE GENERATED IN SIOP CNS GCT 96. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Rolf Dieter Kortmann
- Department of Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany
| | - Didier Frappaz
- Institute d’He′mato-Oncologie Pe′diatrique, Centre Leon Berard, Lyon, France
| | - Frank Saran
- Department of Radiotherapy, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Maria Luisa Garre
- Neuro-Oncology Unit, Department of Pedeatric Hematology, Genova, Italy
| | | | - Umberto Ricardi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit,, Torino, Italy
| | - Thomas Czech
- Department of Neurosurgery, University of Vienna Medical School, Veinna, Austria
| | - Claire Alapetite
- Department for Paediatric Hematology/Oncology, Radiation Oncology Department, Paris & Proton Therapy Center, Orsay, Institut Curie, Paris, France
| | - James C Nicholson
- Department of Paediatric Oncology, Addenbrookes Hospital, Cambridge, UK
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Kuhrt CA, Alapetite C, Kortmann RD, Nicholson JC, Müller JE, Garre ML, Czech T, Ricardi U, Saran F, Frappaz D, Calaminus G. GERM-13. PITUITARY FAILURES IN CNS GERMINOMA. EXPERIENCE GENERATED IN SIOP CNS GCT 96. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Claire Alapetite
- Department for Paediatric Hematology/Oncology, Radiation Oncology Department, Paris & Proton Therapy Center, Orsay, Institut Curie, Paris, France
| | - Rolf Dieter Kortmann
- Department of Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany
| | - James C Nicholson
- Department of Paediatric Oncology, Addenbrookes Hospital, Cambridge, UK
| | | | - Maria Luisa Garre
- Neuro-Oncology Unit, Department of Pedeatric Hematology and Oncology, G. Gaslini Children’s Hospital, Genova, Italy
| | - Thomas Czech
- Department of Neurosurgery, University of Vienna Medical School, Vienna, Austria
| | - Umberto Ricardi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Turin, Torino, Italy
| | - Frank Saran
- Department of Radiotherapy, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Didier Frappaz
- Institute d’He′mato-Oncologie Pe′diatrique, Centre Leon Berard, Lyon, France
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21
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Shah R, Xia C, Krailo M, Amatruda JF, Arul SG, Billmire DF, Brady WE, Covens A, Gershenson DM, Hale JP, Hurteau J, Murray MJ, Nicholson JC, Olson TA, Pashankar F, Rodriguez-Galindo C, Shaikh F, Stark D, Frazier AL, Stoneham S. Is carboplatin-based chemotherapy as effective as cisplatin-based chemotherapy in the treatment of advanced-stage dysgerminoma in children, adolescents and young adults? Gynecol Oncol 2018; 150:253-260. [PMID: 29884437 DOI: 10.1016/j.ygyno.2018.05.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Dysgerminoma is the most common malignant ovarian germ cell tumor (GCT) with peak incidence during adolescence and young adulthood. Current standard of care for patients with disease that has spread outside of the ovary (advanced-stage) utilizes platin-based chemotherapy regimens. The study objective was to compare clinical outcomes between platin-based (carboplatin versus cisplatin) strategies across all age groups (children < 11 years (y), adolescents = 11-25 y and young adult women > 25 y) for advanced-stage dysgerminoma. METHODS The Malignant Germ Cell Tumor International Consortium (MaGIC) pooled data from six GCT trials (3 = pediatric, 3 = adult) conducted internationally by pediatric and gynecologic oncology clinical trial organizations (CTOs) between 1983 and 2009. Newly diagnosed patients, with advanced-stage (FIGO IC-IV) dysgerminoma, who received either carboplatin- or cisplatin-based chemotherapy were eligible for analysis. RESULTS 126 eligible patients were identified; 56 patients (38 = pediatric, 18 = adult) received carboplatin-based and 70 patients (50 = pediatric, 20 = adult) received cisplatin-based chemotherapy. Mean age was 20 y (range = 6-46 y). The median follow-up was 10.3 y (range = 0.17-21.7 y). The five-year event-free survival (EFS5) and overall survival (OS5) was 0.94 (95%CI, 0.88-0.97) and 0.96 (95%CI, 0.91-0.99) respectively. Survival outcomes were comparable between carboplatin-(EFS5 = 0.96 (95%CI, 0.85-0.99), OS5 = 0.96 (95%CI, 0.85-0.99)) and cisplatin-(EFS5 = 0.93 (95%CI, 0.83-0.97), OS5 = 0.96 (95%CI, 0.87-0.99)) based regimens. Across three age groups, comparison of the EFS5 (<11 y = 0.1, 11-25 y = 0.91 (95%CI, 0.82-0.96), >25 y = 0.97 (95%CI, 0.81-0.99)) and OS5 (<11 y = 0.1, 11-25 y = 0.95 (95%CI, 0.87-0.99), >25 y = 0.97 (95%CI, 0.81-0.99)) did not demonstrate any statistically significant differences in outcomes. CONCLUSIONS Patients diagnosed with dysgerminoma have an excellent OS, across all ages, even in the context of metastatic disease. Data from three large CTOs supports the investigation of carboplatin-based regimens in the frontline treatment of all patients with advanced-stage dysgerminoma to minimize treatment-related toxicities.
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Affiliation(s)
- Rachana Shah
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH, USA.
| | | | - Mark Krailo
- Children's Oncology Group, USA; University of Southern California, CA, USA
| | - James F Amatruda
- University of Texas Southwestern Medical Center, Children's Medical Center, TX, USA
| | - Suren G Arul
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | - William E Brady
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | | | - Juliet P Hale
- Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals Trust, Newcastle Upon Tyne, UK
| | - Jean Hurteau
- North Shore University Health System, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Matthew J Murray
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Thomas A Olson
- Aflac Cancer Center, Children's Healthcare of Atlanta, Emory University, GA, USA
| | | | | | - Furqan Shaikh
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Daniel Stark
- Leeds Institute of Cancer Studies and Pathology, Leeds Institute of Oncology and St. James's University Hospital, Leeds, UK
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, MA, USA
| | - Sara Stoneham
- Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, UK
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Stoneham SJ, Hale JP, Rodriguez-Galindo C, Dang H, Olson T, Murray M, Amatruda JF, Thornton C, Arul GS, Billmire D, Krailo M, Stark D, Covens A, Hurteau J, Stenning S, Nicholson JC, Gershenson D, Frazier AL. Adolescents and Young Adults With a "Rare" Cancer: Getting Past Semantics to Optimal Care for Patients With Germ Cell Tumors. Oncologist 2018; 23:272. [PMID: 29449513 PMCID: PMC5813761 DOI: 10.1634/theoncologist.2014-0009erratum] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Murray MJ, Watson HL, Ward D, Bailey S, Ferraresso M, Nicholson JC, Gnanapragasam VJ, Thomas B, Scarpini CG, Coleman N. "Future-Proofing" Blood Processing for Measurement of Circulating miRNAs in Samples from Biobanks and Prospective Clinical Trials. Cancer Epidemiol Biomarkers Prev 2017; 27:208-218. [PMID: 29254935 DOI: 10.1158/1055-9965.epi-17-0657] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/16/2017] [Accepted: 11/22/2017] [Indexed: 12/12/2022] Open
Abstract
Background: Quantifying circulating nucleic acids is an important new approach to cancer diagnosis/monitoring.Methods: We compared the suitability of serum versus plasma for measuring miRNAs using qRT-PCR and assessed how preanalytic variables that can affect circulating tumor DNA (ctDNA) quantification in plasma also influence miRNA levels.Results: Across 62 blood-derived specimens, plasma samples in EDTA, Streck-DNA, and Streck-RNA tubes showed significantly higher Ct values for multiple housekeeping miRNAs, compared with serum samples. For the EDTA-plasma tubes, this difference was only seen when including the high-speed centrifugation protocol used to optimize ctDNA extraction. In plasma samples derived from blood stored at room temperature for up to 14 days (conditions that typically apply to samples processed for biobanking), levels of endogenous housekeeping miRNAs gradually increased, in parallel with the hemolysis marker hsa-miR-451a, consistent with release from blood cells/platelets. It was necessary to normalize levels of the housekeeping miRNAs to those of hsa-miR-451a, to obtain the stable values needed for referencing test miRNA levels.Conclusions: Our data indicate that plasma samples prepared for ctDNA extraction are suboptimal for miRNA quantification and require the incorporation of multiple data normalization steps. For prospective studies designed to measure both miRNAs and ctDNA, the most suitable approach would be to obtain both serum (for miRNAs) and plasma (for ctDNA). If only plasma can be collected, we recommend an initial low-speed centrifugation step, followed by aliquoting the supernatant into parallel samples, one for direct miRNA quantification, and the other for a further high-speed centrifugation step to optimize ctDNA retrieval.Impact: These recommendations will help "future-proof" clinical studies in which quantification of circulating miRNAs is a component. Cancer Epidemiol Biomarkers Prev; 27(2); 208-18. ©2017 AACR.
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Affiliation(s)
- Matthew J Murray
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom. .,Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Hannah L Watson
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom
| | - Dawn Ward
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom
| | - Shivani Bailey
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom
| | - Marta Ferraresso
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Benjamin Thomas
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Cinzia G Scarpini
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom
| | - Nicholas Coleman
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom. .,Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Murray MJ, Bailey S, Heinemann K, Mann J, Göbel UK, Saran F, Hale JP, Calaminus G, Nicholson JC. Treatment and outcomes of UK and German patients with relapsed intracranial germ cell tumors following uniform first-line therapy. Int J Cancer 2017; 141:621-635. [PMID: 28463397 DOI: 10.1002/ijc.30755] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/06/2017] [Indexed: 01/07/2023]
Abstract
We aimed to retrospectively assess treatments/outcomes, including the value of high-dose-chemotherapy and autologous-stem-cell-rescue (HDC + AuSCR) and re-irradiation, in a large, European patient-cohort with relapsed intracranial germ-cell-tumors (GCTs) receiving uniform first-line therapy, including radiotherapy as standard-of-care. Fifty-eight UK/German patients (48 male/10 female) with relapsed intracranial-GCTs [13 germinoma/45 non-germinomatous GCT (NGGCT)] treated 1996-2010 as per the SIOP-CNS-GCT-96 protocol were evaluated. For germinoma, six patients relapsed with germinoma and five with NGGCT (one palliative, one teratoma patient excluded). Five-year overall-survival (OS) for the whole-group (n = 11) was 55%. Four of six germinoma relapses and two of five relapsing with NGGCT were salvaged; patients were salvaged with either standard-dose-chemotherapy (SDC) and re-irradiation or HDC + AuSCR with/without re-irradiation. Of 45 relapsed NGGCT patients, 13 were excluded (three non-protocol adherence, five teratoma, five palliation). Five-year OS for the remaining 32 relapsed malignant NGGCT patients treated with curative intent was 9% (95%CI: 2-26%). By treatment received, 5-year OS for the 10 patients receiving SDC and 22 patients treated with intention for HDC + AuSCR was 0% (0-0%) and 14% (3-36%), respectively. The three relapsed NGGCT survivors had raised HCG markers alone; two received additional irradiation. Patients with relapsed germinoma had better 5-year OS than those with relapsed NGGCT (55 vs. 9%; p = 0.007). Patients with relapsed germinoma were salvaged both with SDC and re-irradiation or HDC + AuSCR with/without re-irradiation; both represent valid treatment options. Outcomes for malignant relapse following initial diagnosis of NGGCT were exceptionally poor; the few survivors received thiotepa-based HDC + AuSCR, which is a treatment option at first malignant relapse for such patients, with further surgery/irradiation where feasible.
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Affiliation(s)
- Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom
| | - Shivani Bailey
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom
| | - Katja Heinemann
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Robert Koch Strasse, Bonn, Germany
| | - Jillian Mann
- Department of Paediatric Haematology and Oncology, Birmingham Children's Hospital, Birmingham, B4 6NH, United Kingdom
| | - Ulrich K Göbel
- German Paediatric Surveillance Unit (ESPED), Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Frank Saran
- Department of Oncology, Royal Marsden Hospital, Sutton, Surrey, SM2 5PT, United Kingdom
| | - Juliet P Hale
- Department of Paediatric Haematology and Oncology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne, Tyne and Wear, NE1 4LP, United Kingdom
| | - Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Robert Koch Strasse, Bonn, Germany
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom
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Willemsen RH, Delgado-Carballar V, Elleri D, Thankamony A, Burke GAA, Nicholson JC, Dunger DB. Tolvaptan use during hyperhydration in paediatric intracranial lymphoma with SIADH. Endocrinol Diabetes Metab Case Rep 2016; 2016:EDM160066. [PMID: 27857840 PMCID: PMC5097145 DOI: 10.1530/edm-16-0066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/29/2016] [Indexed: 11/08/2022] Open
Abstract
An 11-year-old boy developed severe syndrome of inappropriate antidiuretic hormone secretion (SIADH) after diagnosis of an intracranial B-cell lymphoma. His sodium levels dropped to 118-120 mmol/L despite 70% fluid restriction. For chemotherapy, he required hyperhydration, which posed a challenge because of severe hyponatraemia. Tolvaptan is an oral, highly selective arginine vasopressin V2-receptor antagonist, which has been licensed in adults for the management of SIADH and has been used in treating paediatric heart failure. Tolvaptan gradually increased sodium levels and allowed liberalisation of fluid intake and hyperhydration. Tolvaptan had profound effects on urinary output in our patient with increases up to 8 mL/kg/h and required close monitoring of fluid balance, frequent sodium measurements and adjustments to intake. After hyperhydration, tolvaptan was stopped, and the lymphoma went into remission with reversal of SIADH. We report one of the first uses of tolvaptan in a child with SIADH, and it was an effective and safe treatment to manage severe SIADH when fluid restriction was not possible or effective. However, meticulous monitoring of fluid balance and sodium levels and adjustments of fluid intake are required to prevent rapid sodium changes. LEARNING POINTS Tolvaptan can be used in paediatric patients with SIADH to allow hyperhydration during chemotherapy.Tolvaptan has profound effects on urinary output and meticulous monitoring of fluid balance and sodium
levels is therefore warranted.Tolvaptan was well tolerated without significant side effects.
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Affiliation(s)
- Ruben H Willemsen
- Department of Paediatric Endocrinology , University of Cambridge, Cambridge , UK
| | | | - Daniela Elleri
- Department of Paediatric Endocrinology , University of Cambridge, Cambridge , UK
| | - Ajay Thankamony
- Department of Paediatric Endocrinology , University of Cambridge, Cambridge , UK
| | - G A Amos Burke
- Department of Paediatric Haematology and Oncology , Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge , UK
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology , Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge , UK
| | - David B Dunger
- Department of Paediatric Endocrinology , University of Cambridge, Cambridge , UK
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Shaikh F, Murray MJ, Amatruda JF, Coleman N, Nicholson JC, Hale JP, Pashankar F, Stoneham SJ, Poynter JN, Olson TA, Billmire DF, Stark D, Rodriguez-Galindo C, Frazier AL. Paediatric extracranial germ-cell tumours. Lancet Oncol 2016; 17:e149-e162. [PMID: 27300675 DOI: 10.1016/s1470-2045(15)00545-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 12/12/2022]
Abstract
Management of paediatric extracranial germ-cell tumours carries a unique set of challenges. Germ-cell tumours are a heterogeneous group of neoplasms that present across a wide age range and vary in site, histology, and clinical behaviour. Patients with germ-cell tumours are managed by a diverse array of specialists. Thus, staging, risk stratification, and treatment approaches for germ-cell tumours have evolved disparately along several trajectories. Paediatric germ-cell tumours differ from the adolescent and adult disease in many ways, leading to complexities in applying age-appropriate, evidence-based care. Suboptimal outcomes remain for several groups of patients, including adolescents, and patients with extragonadal tumours, high tumour markers at diagnosis, or platinum-resistant disease. Survivors have significant long-term toxicities. The challenge moving forward will be to translate new insights from molecular studies and collaborative clinical data into improved patient outcomes. Future trials will be characterised by improved risk-stratification systems, biomarkers for response and toxic effects, rational reduction of therapy for low-risk patients and novel approaches for poor-risk patients, and improved international collaboration across paediatric and adult cooperative research groups.
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Affiliation(s)
- Furqan Shaikh
- Division of Haematology and Oncology, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada.
| | - Matthew J Murray
- Department of Pathology, University of Cambridge, Cambridge, UK; Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - James F Amatruda
- Department of Pediatrics, Department of Molecular Biology and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, TX, USA
| | - Nicholas Coleman
- Department of Pathology, University of Cambridge, Cambridge, UK; Department of Histopathology, Addenbrooke's Hospital, Hills Road, Cambridge, UK
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Juliet P Hale
- Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Sara J Stoneham
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jenny N Poynter
- Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Thomas A Olson
- Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA, USA
| | | | - Daniel Stark
- Leeds Institute of Cancer and Pathology, University of Leeds, UK
| | | | - A Lindsay Frazier
- Boston Children's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
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Pashankar F, Hale JP, Dang H, Krailo M, Brady WE, Rodriguez-Galindo C, Nicholson JC, Murray MJ, Bilmire DF, Stoneham S, Arul GS, Olson TA, Stark D, Shaikh F, Amatruda JF, Covens A, Gershenson DM, Frazier AL. Is adjuvant chemotherapy indicated in ovarian immature teratomas? A combined data analysis from the Malignant Germ Cell Tumor International Collaborative. Cancer 2016; 122:230-7. [PMID: 26485622 PMCID: PMC5134834 DOI: 10.1002/cncr.29732] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is a debate regarding the management of ovarian immature teratomas (ITs). In adult women, postoperative chemotherapy is standard except for stage I, grade 1 disease, whereas surgery alone is standard in pediatric patients. To determine the role of chemotherapy, a pooled analysis of pediatric and adult clinical trials was conducted. METHODS Data from 7 pediatric trials and 2 adult trials were merged in the Malignant Germ Cell International Collaborative data set. Four trials included patients with newly diagnosed pure ovarian ITs and were selected (Pediatric Oncology Group/Children's Cancer Group Intergroup Study (INT 0106), Second UKCCSG Germ Cell Tumor Study (GC2), Gynecologic Oncology Group (GOG 0078 and GOG 0090). Adult and pediatric trials were analyzed separately. The primary outcome measures were event-free survival (EFS) and overall survival (OS). RESULTS One hundred seventy-nine patients were included (98 pediatric patients and 81 adult patients). Ninety pediatric patients were treated with surgery alone, whereas all adult patients received chemotherapy. The 5-year EFS and OS were 91% and 99%, respectively, for the pediatric cohort and 87% and 93%, respectively, for the adults. There were no relapses in grade 1 patients, regardless of the stage or age. Only 1 adult patient with a grade 2 IT relapsed. Among grade 3 patients, the 5-year EFS was 0.92 (0.72-0.98) for stage I/II and 0.52 (0.22-0.75) for stage III in the pediatric cohort (P = .005) and 0.91 (0.69-0.98) for stage I/II and 0.65 (0.39-0.83) for stage III/IV in the adult cohort (P = .01). Postoperative chemotherapy did not decrease relapses in the pediatric cohort. CONCLUSIONS The grade was the most important risk factor for relapse in ovarian ITs. Among grade 3 patients, the stage was significantly associated with relapse. Adjuvant chemotherapy did not decrease relapses in the pediatric cohort; its role in adults remains unresolved. Cancer 2016;122:230-237. © 2015 American Cancer Society.
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Affiliation(s)
| | - Juliet P. Hale
- Department of Paediatric Oncology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals Trust, Newcastle Upon Tyne, United Kingdom
| | - Ha Dang
- Children’s Oncology Group, Monrovia, California
| | - Mark Krailo
- University of Southern California, Los Angeles, California
| | - William E. Brady
- Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, New York
| | | | - James C. Nicholson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Matthew J. Murray
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Sara Stoneham
- Children’s and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom
| | - G. Suren Arul
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Thomas A. Olson
- Aflac Cancer Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Daniel Stark
- Leeds Institute of Cancer Studies and Pathology, Leeds Institute of Oncology and St. James’s University Hospital, Leeds, United Kingdom
| | | | - James F. Amatruda
- University of Texas Southwestern Medical Center, Dallas, Texas,Children’s Medical Center, Dallas, Texas
| | | | | | - A. Lindsay Frazier
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, Massachusetts
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28
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Murray MJ, Bartels U, Nishikawa R, Fangusaro J, Matsutani M, Nicholson JC. Consensus on the management of intracranial germ-cell tumours. Lancet Oncol 2015; 16:e470-e477. [PMID: 26370356 DOI: 10.1016/s1470-2045(15)00244-2] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/27/2015] [Accepted: 04/02/2015] [Indexed: 11/19/2022]
Abstract
The management of intracranial germ-cell tumours is complex because of varied clinical presentations, tumour sites, treatments and outcomes, and the need for multidisciplinary input. Participants of the 2013 Third International CNS Germ Cell Tumour Symposium (Cambridge, UK) agreed to undertake a multidisciplinary Delphi process to identify consensus in the clinical management of intracranial germ-cell tumours. 77 delegates from the symposium were selected as suitable experts in the field and were invited to participate in the Delphi survey, of which 64 (83%) responded to the invitation. Invited participants represented multiple disciplines from Asia, Australasia, Europe, and the Americas. 38 consensus statements encompassing aspects of intracranial germ-cell tumour work-up, staging, treatment, and follow-up were prepared. To achieve consensus, statements required at least 70% agreement from at least 60% of respondents. Overall, 34 (89%) of 38 statements met consensus criteria. This international Delphi approach has defined key areas of consensus that will help guide and streamline clinical management of patients with intracranial germ-cell tumours. Additionally, the Delphi approach identified areas of different understanding and clinical practice internationally in the management of these tumours, areas which should be the focus of future collaborative studies. Such efforts should translate into improved patient outcomes.
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Affiliation(s)
- Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Ute Bartels
- Pediatric Brain Tumour Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Centre, Hidaka, Japan
| | - Jason Fangusaro
- Department of Pediatric Hematology/Oncology, Neuro-Oncology and Stem Cell Transplantation, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Masao Matsutani
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Centre, Hidaka, Japan
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Trust, Cambridge, UK.
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29
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Olson TA, Murray MJ, Rodriguez-Galindo C, Nicholson JC, Billmire DF, Krailo MD, Dang HM, Amatruda JF, Thornton CM, Arul GS, Stoneham SJ, Pashankar F, Stark D, Shaikh F, Gershenson DM, Covens A, Hurteau J, Stenning SP, Feldman DR, Grimison PS, Huddart RA, Sweeney C, Powles T, Lopes LF, dos Santos Agular S, Chinnaswamy G, Khaleel S, Abouelnaga S, Hale JP, Frazier AL. Pediatric and Adolescent Extracranial Germ Cell Tumors: The Road to Collaboration. J Clin Oncol 2015; 33:3018-28. [PMID: 26304902 PMCID: PMC4979195 DOI: 10.1200/jco.2014.60.5337] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
During the past 35 years, survival rates for children with extracranial malignant germ cell tumors (GCTs) have increased significantly. Success has been achieved primarily through the application of platinum-based chemotherapy regimens; however, clinical challenges in GCTs remain. Excellent outcomes are not distributed uniformly across the heterogeneous distribution of age, histologic features, and primary tumor site. Despite good outcomes overall, the likelihood of a cure for certain sites and histologic conditions is less than 50%. In addition, there are considerable long-term treatment-related effects for survivors. Even modest cisplatin dosing can cause significant long-term morbidities. A particular challenge in designing new therapies for GCT is that a variety of specialists use different risk stratifications, staging systems, and treatment approaches for three distinct age groups (childhood, adolescence, and young adulthood). Traditionally, pediatric cancer patients younger than 15 years have been treated by pediatric oncologists in collaboration with their surgical specialty colleagues. Adolescents and young adults with GCTs often are treated by medical oncologists, urologists, or gynecologic oncologists. The therapeutic dilemma for all is how to best define disease risk so that therapy and toxicity can be appropriately reduced for some patients and intensified for others. Further clinical and biologic insights can only be achieved through collaborations that do not set limitations by age, sex, and primary tumor site. Therefore, international collaborations, spanning different cooperative groups and disciplines, have been developed to address these challenges.
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Affiliation(s)
- Thomas A. Olson
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Matthew J. Murray
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Carlos Rodriguez-Galindo
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - James C. Nicholson
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Deborah F. Billmire
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Mark D. Krailo
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ha M. Dang
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - James F. Amatruda
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Claire M. Thornton
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - G. Suren Arul
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sara J. Stoneham
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Farzana Pashankar
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Daniel Stark
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Furqan Shaikh
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - David M. Gershenson
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Allan Covens
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jean Hurteau
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sally P. Stenning
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Darren R. Feldman
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Peter S. Grimison
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Robert A. Huddart
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Christopher Sweeney
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Thomas Powles
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Luiz Fernando Lopes
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Simone dos Santos Agular
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Girish Chinnaswamy
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sahar Khaleel
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sherif Abouelnaga
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Juliet P. Hale
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - A. Lindsay Frazier
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Willett AB, Weisman JA, Nicholson JC, Vijayakumar S. Customizable 3D Printing for LDR Prostatic Seed Shielding. Brachytherapy 2015. [DOI: 10.1016/j.brachy.2015.02.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bailey S, Murray MJ, Witkowski L, Hook E, Hasselblatt M, Crawford R, Foulkes WD, Tischkowitz M, Nicholson JC. Biallelic somatic SMARCA4 mutations in small cell carcinoma of the ovary, hypercalcemic type (SCCOHT). Pediatr Blood Cancer 2015; 62:728-30. [PMID: 25307865 DOI: 10.1002/pbc.25279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/25/2014] [Indexed: 01/15/2023]
Abstract
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare, aggressive tumor that primarily affects young women. SCCOHT has recently been identified as a monogenic disorder caused by germline and/or somatic SMARCA4 mutations. We describe a 15-year-old Caucasian female with a SCCOHT harboring a previously unreported somatic mutation in the SMARCA4 gene (c.1757delA; p.K586.fs) with loss of heterozygosity. No germline mutation was identified. Subsequent immunohistochemical staining confirmed loss of SMARCA4 protein. These molecular findings will aid with SCCOHT diagnosis through immunohistochemical staining for SMARCA4 and in the future may have implications for the management of this disease.
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Affiliation(s)
- Shivani Bailey
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge, UK
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Frazier AL, Hale JP, Rodriguez-Galindo C, Dang H, Olson T, Murray MJ, Amatruda JF, Thornton C, Arul GS, Billmire D, Shaikh F, Pashankar F, Stoneham S, Krailo M, Nicholson JC. Revised risk classification for pediatric extracranial germ cell tumors based on 25 years of clinical trial data from the United Kingdom and United States. J Clin Oncol 2015; 33:195-201. [PMID: 25452439 PMCID: PMC4279239 DOI: 10.1200/jco.2014.58.3369] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To risk stratify malignant extracranial pediatric germ cell tumors (GCTs). PATIENTS AND METHODS Data from seven GCT trials conducted by the Children's Oncology Group (United States) or the Children's Cancer and Leukemia Group (United Kingdom) between 1985 and 2009 were merged to create a data set of patients with stage II to IV disease treated with platinum-based therapy. A parametric cure model was used to evaluate the prognostic importance of age, tumor site, stage, histology, tumor markers, and treatment regimen and estimate the percentage of patients who achieved long-term disease-free (LTDF) survival in each subgroup of the final model. Validation of the model was conducted using the bootstrap method. RESULTS In multivariable analysis of 519 patients with GCTs, stage IV disease (P = .001), age ≥ 11 years (P < .001), and tumor site (P < .001) were significant predictors of worse LTDF survival. Elevated alpha-fetoprotein (AFP) ≥ 10,000 ng/mL was associated with worse outcome, whereas pure yolk sac tumor (YST) was associated with better outcome, although neither met criteria for statistical significance. The analysis identified a group of patients age > 11 years with either stage III to IV extragonadal tumors or stage IV ovarian tumors with predicted LTDF survival < 70%. A bootstrap procedure showed retention of age, tumor site, and stage in > 94%, AFP in 12%, and YST in 27% of the replications. CONCLUSION Clinical trial data from two large national pediatric clinical trial organizations have produced a new evidence-based risk stratification of malignant pediatric GCTs that identifies a poor-risk group warranting intensified therapy.
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Affiliation(s)
- A Lindsay Frazier
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT.
| | - Juliet P Hale
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Carlos Rodriguez-Galindo
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Ha Dang
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Thomas Olson
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Matthew J Murray
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - James F Amatruda
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Claire Thornton
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - G Suren Arul
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Deborah Billmire
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Furqan Shaikh
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Farzana Pashankar
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Sara Stoneham
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Mark Krailo
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - James C Nicholson
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
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Weisman JA, Nicholson JC, Tappa K, Jammalamadaka U, Wilson CG, Mills DK. Antibiotic and chemotherapeutic enhanced three-dimensional printer filaments and constructs for biomedical applications. Int J Nanomedicine 2015; 10:357-70. [PMID: 25624758 PMCID: PMC4296964 DOI: 10.2147/ijn.s74811] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Three-dimensional (3D) printing and additive manufacturing holds potential for highly personalized medicine, and its introduction into clinical medicine will have many implications for patient care. This paper demonstrates the first application of 3D printing as a method for the potential sustained delivery of antibiotic and chemotherapeutic drugs from constructs for patient treatment. Our design is focused on the on-demand production of anti-infective and chemotherapeutic filaments that can be used to create discs, beads, catheters, or any medical construct using a 3D printing system. The design parameters for this project were to create a system that could be modularly loaded with bioactive agents. All 3D-printed constructs were loaded with either gentamicin or methotrexate and were optimized for efficient and extended antibacterial and cancer growth-inhibiting cytostatic activity. Preliminary results demonstrate that combining gentamicin and methotrexate with polylactic acid forms a composite possessing a superior combination of strength, versatility, and enhanced drug delivery. Antibacterial effects and a reduction in proliferation of osteosarcoma cells were observed with all constructs, attesting to the technical and clinical viability of our composites. In this study, 3D constructs were loaded with gentamicin and methotrexate, but the method can be extended to many other drugs. This method could permit clinicians to provide customized and tailored treatment that allows patient-specific treatment of disease and has significant potential for use as a tunable drug delivery system with sustained-release capacity for an array of biomedical applications.
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Affiliation(s)
- Jeffery A Weisman
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Technical University, Ruston, LA, USA
| | - James C Nicholson
- Nanosystems Engineering, Louisiana Technical University, Ruston, LA, USA
| | - Karthik Tappa
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Technical University, Ruston, LA, USA
| | - UdayaBhanu Jammalamadaka
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Technical University, Ruston, LA, USA
| | - Chester G Wilson
- Nanosystems Engineering, Louisiana Technical University, Ruston, LA, USA
| | - David K Mills
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Technical University, Ruston, LA, USA ; School of Biological Sciences, Louisiana Technical University, Ruston, LA, USA
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Murray MJ, Raby KL, Saini HK, Bailey S, Wool SV, Tunnacliffe JM, Enright AJ, Nicholson JC, Coleman N. Solid tumors of childhood display specific serum microRNA profiles. Cancer Epidemiol Biomarkers Prev 2014; 24:350-60. [PMID: 25416717 DOI: 10.1158/1055-9965.epi-14-0669] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Serum biomarkers for diagnosis and risk stratification of childhood solid tumors would improve the accuracy/timeliness of diagnosis and reduce the need for invasive biopsies. We hypothesized that differential expression and/or release of microRNAs (miRNAs) by such tumors may be detected as altered serum miRNA profiles. METHODS We undertook global quantitative reverse transcription PCR (qRT-PCR) miRNA profiling (n = 741) on RNA from 53 serum samples, representing 33 diagnostic cases of common childhood cancers plus 20 controls. Technical confirmation was performed in a subset of 21 cases, plus four independent samples. RESULTS We incorporated robust quality control steps for RNA extraction, qRT-PCR efficiency and hemolysis quantification. We evaluated multiple methods to normalize global profiling data and identified the 'global mean' approach as optimal. We generated a panel of six miRNAs that were most stable in pediatric serum samples and therefore most suitable for normalization of targeted miRNA qRT-PCR data. Tumor-specific serum miRNA profiles were identified for each tumor type and selected miRNAs underwent confirmatory testing. We identified a panel of miRNAs (miR-124-3p/miR-9-3p/miR-218-5p/miR-490-5p/miR-1538) of potential importance in the clinical management of neuroblastoma, as they were consistently highly overexpressed in MYCN-amplified high-risk cases (MYCN-NB). We also derived candidate miRNA panels for noninvasive differential diagnosis of a liver mass (hepatoblastoma vs. combined MYCN-NB/NB), an abdominal mass (Wilms tumor vs. combined MYCN-NB/NB), and sarcoma subtypes. CONCLUSIONS This study describes a pipeline for robust diagnostic serum miRNA profiling in childhood solid tumors, and has identified candidate miRNA profiles for prospective testing. IMPACT We propose a new noninvasive method with the potential to diagnose childhood solid tumors.
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Affiliation(s)
- Matthew J Murray
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom. Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom. University of Cambridge Department of Paediatrics, Addenbrooke's Hospital, Cambridge, United Kingdom.
| | - Katie L Raby
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom
| | - Harpreet K Saini
- European Molecular Biology Laboratory European Bioinformatics Institute (EMBL-EBI), Hinxton, Cambridge, United Kingdom
| | - Shivani Bailey
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom. Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom
| | - Sophie V Wool
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom
| | - Jane M Tunnacliffe
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom
| | - Anton J Enright
- European Molecular Biology Laboratory European Bioinformatics Institute (EMBL-EBI), Hinxton, Cambridge, United Kingdom
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom
| | - Nicholas Coleman
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom. Department of Histopathology, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom.
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Murray MJ, Nicholson JC, Coleman N. Biology of childhood germ cell tumours, focussing on the significance of microRNAs. Andrology 2014; 3:129-39. [PMID: 25303610 PMCID: PMC4409859 DOI: 10.1111/andr.277] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/19/2014] [Accepted: 08/21/2014] [Indexed: 02/06/2023]
Abstract
Genomic and protein-coding transcriptomic data have suggested that germ cell tumours (GCTs) of childhood are biologically distinct from those of adulthood. Global messenger RNA profiles segregate malignant GCTs primarily by histology, but then also by age, with numerous transcripts showing age-related differential expression. Such differences are likely to account for the heterogeneous clinico-pathological behaviour of paediatric and adult malignant GCTs. In contrast, as global microRNA signatures of human tumours reflect their developmental lineage, we hypothesized that microRNA profiles would identify common biological abnormalities in all malignant GCTs owing to their presumed shared origin from primordial germ cells. MicroRNAs are short, non-protein-coding RNAs that regulate gene expression via translational repression and/or mRNA degradation. We showed that all malignant GCTs over-express the miR-371-373 and miR-302/367 clusters, regardless of patient age, histological subtype or anatomical tumour site. Furthermore, bioinformatic approaches and subsequent Gene Ontology analysis revealed that these two over-expressed microRNAs clusters co-ordinately down-regulated genes involved in biologically significant pathways in malignant GCTs. The translational potential of this finding has been demonstrated with the detection of elevated serum levels of miR-371-373 and miR-302/367 microRNAs at the time of malignant GCT diagnosis, with levels falling after treatment. The tumour-suppressor let-7 microRNA family has also been shown to be universally down-regulated in malignant GCTs, because of abundant expression of the regulatory gene LIN28. Low let-7 levels resulted in up-regulation of oncogenes including MYCN, AURKB and LIN28 itself, the latter through a direct feedback mechanism. Targeting LIN28, or restoring let-7 levels, both led to effective inhibition of this pathway. In summary, paediatric malignant GCTs show biological differences from their adult counterparts at a genomic and protein-coding transcriptome level, whereas they both display very similar microRNA expression profiles. These similarities and differences may be exploited for diagnostic and/or therapeutic purposes.
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Affiliation(s)
- M J Murray
- Department of Pathology, University of Cambridge, Cambridge, UK; Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge, UK
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Stoneham SJ, Hale JP, Rodriguez-Galindo C, Dang H, Olson T, Murray M, Amatruda JF, Thornton C, Arul GS, Billmire D, Krailo M, Stark D, Covens A, Hurteau J, Stenning S, Nicholson JC, Gershenson D, Frazier AL. Adolescents and young adults with a "rare" cancer: getting past semantics to optimal care for patients with germ cell tumors. Oncologist 2014; 19:689-92. [PMID: 24899644 PMCID: PMC4077446 DOI: 10.1634/theoncologist.2014-0009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 01/07/2014] [Accepted: 04/22/2014] [Indexed: 11/17/2022] Open
Abstract
Because the tumors of adolescence and young adulthood (AYA) are distinct from those that occur earlier and later in life, the most common tumors in this age group are termed “rare.” We offer a collaborative, cross-disciplinary, evidence-based approach, advocated and funded by civil society, to advance the field of germ cell tumor and potentially to apply to other rare AYA tumors.
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Affiliation(s)
- Sara J Stoneham
- Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom;
| | - Juliet P Hale
- Department of Paediatric Oncology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals trust, Newcastle upon Tyne, United Kingdom
| | - Carlos Rodriguez-Galindo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ha Dang
- Children's Oncology Group, Monrovia, California, USA
| | - Thomas Olson
- Department of Pediatric Oncology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | - Matthew Murray
- Department of Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - James F Amatruda
- University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas, USA
| | - Claire Thornton
- Department of Pathology, Royal Victoria Hospital, Belfast Health Trust, Belfast, United Kingdom
| | - G Suren Arul
- Department of Pediatric Surgery, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Mark Krailo
- Children's Oncology Group, Monrovia, California, USA
| | - Dan Stark
- Department of Medical Oncology, St. James's Institute of Oncology, St. James University Hospital, Leeds, United Kingdom
| | - Al Covens
- Department of Gynecology Oncology, University of Toronto, Sunnybrook Health Sciences Center, Ontario, Canada
| | - Jean Hurteau
- Department of Gynecologic Oncology, North Shore University Health System, Evanston, Illinois, USA
| | - Sally Stenning
- Medical Research Council Clinical Trials Unit, London, United Kingdom
| | - James C Nicholson
- Department of Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - David Gershenson
- University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas, USA
| | - A Lindsay Frazier
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts, USA
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Gillis AJM, Rijlaarsdam MA, Eini R, Dorssers LCJ, Biermann K, Murray MJ, Nicholson JC, Coleman N, Dieckmann KP, Belge G, Bullerdiek J, Xu T, Bernard N, Looijenga LHJ. Targeted serum miRNA (TSmiR) test for diagnosis and follow-up of (testicular) germ cell cancer patients: a proof of principle. Mol Oncol 2013; 7:1083-92. [PMID: 24012110 DOI: 10.1016/j.molonc.2013.08.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/11/2013] [Accepted: 08/07/2013] [Indexed: 01/07/2023] Open
Abstract
Germ cell cancers (GCC) are the most frequent malignancy in young Caucasian males. GCC can consist of seminomas (SE) and non-seminomas (malignant NS: embryonal carcinoma (EC), yolk sac tumor (YS), choriocarcinoma (CH) and teratoma (TE)). Current serum-markers used for diagnosis and follow-up (AFP, hCG) are predominantly related to YS and CH and marker positivity can vary during disease. Therefore, stable markers consistently identifying more GCC components, specifically the stem cell components SE and EC, are of interest. Expression of the embryonic stem cell miR-371-3 and miR-302/367 clusters in SE/EC/YS suggest possible application of these micro-RNAs as GCC tumor-markers. The TSmiR protocol constitutes a complete, quality-controlled pipeline for the detection of miRs in serum, based on magnetic bead-based purification and qPCR quantification. As a proof of principle, TSmiR was applied to five independent serum sample series including 80 GCCs, 47 controls, 11 matched pre/post orchidectomy samples and 12 no-GCC testicular masses. GCC serum samples showed a consistent, significant (p < 0.0064) increase of miR-371/372/373/367 levels. Analogous, serum levels returned to baseline after orchidectomy (stage-I disease). Moreover, there was a trend toward higher miR levels in patients with metastasis. These results imply suitability for diagnosis and follow-up. TSmiR showed an overall sensitivity of 98%, clearly outperforming the traditional serum markers AFP/hCG (36%/57%, sensitivity(AFP) = 3%/45%; sensitivity(hCG) = 62%/66%, SE/NS). TSmiR misclassified one tumor as a control. Serum AFP/hCG and TSmiR combined identified all T samples correctly. In conclusion, TSmiR constitutes a highly sensitive and reproducible serum test for GCC patients, suitable to be prospectively tested for diagnostic and follow-up purposes.
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Affiliation(s)
- Ad J M Gillis
- Department of Pathology, Erasmus MC - University Medical Center Rotterdam, Building Be, Room 432, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Witkowski L, Lalonde E, Zhang J, Albrecht S, Hamel N, Cavallone L, May ST, Nicholson JC, Coleman N, Murray MJ, Tauber PF, Huntsman DG, Schönberger S, Yandell D, Hasselblatt M, Tischkowitz MD, Majewski J, Foulkes WD. Familial rhabdoid tumour 'avant la lettre
'-from pathology review to exome sequencing and back again. J Pathol 2013; 231:35-43. [DOI: 10.1002/path.4225] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 06/06/2013] [Accepted: 06/10/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Leora Witkowski
- Program in Cancer Genetics, Department of Oncology and Human Genetics; McGill University, Montreal; Quebec Canada
- Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital; McGill University, Montreal; Quebec Canada
- Department of Human Genetics; McGill University, Montreal; Quebec Canada
| | - Emilie Lalonde
- Department of Human Genetics; McGill University, Montreal; Quebec Canada
- McGill University and Genome Quebec Innovation Center, Montreal; Quebec Canada
| | - Jian Zhang
- Department of Human Genetics; McGill University, Montreal; Quebec Canada
- McGill University and Genome Quebec Innovation Center, Montreal; Quebec Canada
| | - Steffen Albrecht
- Department of Pathology, Montreal Children's Hospital; McGill University Health Centre, Montreal; Quebec Canada
| | - Nancy Hamel
- Program in Cancer Genetics, Department of Oncology and Human Genetics; McGill University, Montreal; Quebec Canada
- Research Institute; McGill University Health Centre, Montreal; Quebec Canada
| | - Luca Cavallone
- Program in Cancer Genetics, Department of Oncology and Human Genetics; McGill University, Montreal; Quebec Canada
- Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital; McGill University, Montreal; Quebec Canada
| | - Sandra Thompson May
- Vermont Cancer Center; University of Vermont College of Medicine; Burlington VT USA
| | - James C Nicholson
- Department of Paediatric Oncology and Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | | | - Matthew J Murray
- Department of Paediatric Oncology and Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
- Department of Pathology; University of Cambridge; UK
| | - Peter F Tauber
- Department of Obstetrics and Gynecology; St. Mary's Hospital; Siegen Germany
| | - David G Huntsman
- British Columbia Cancer Research Center; British Columbia Cancer Agency, Vancouver; BC Canada
- Genetic Pathology Evaluation Center of the Departments of Pathology of Vancouver General Hospital; the Center for Translational and Applied Genomics, and Pathology and Laboratory Medicine; Vancouver BC Canada
| | - Stefan Schönberger
- Department of Paediatric Haematology and Oncology; University Children's Hospital; University of Bonn Germany
| | - David Yandell
- Vermont Cancer Center; University of Vermont College of Medicine; Burlington VT USA
| | | | | | - Jacek Majewski
- Department of Human Genetics; McGill University, Montreal; Quebec Canada
- McGill University and Genome Quebec Innovation Center, Montreal; Quebec Canada
| | - William D Foulkes
- Program in Cancer Genetics, Department of Oncology and Human Genetics; McGill University, Montreal; Quebec Canada
- Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital; McGill University, Montreal; Quebec Canada
- Department of Human Genetics; McGill University, Montreal; Quebec Canada
- Research Institute; McGill University Health Centre, Montreal; Quebec Canada
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Murray MJ, Horan G, Lowis S, Nicholson JC. Highlights from the Third International Central Nervous System Germ Cell Tumour symposium: laying the foundations for future consensus. Ecancermedicalscience 2013; 7:333. [PMID: 23861728 PMCID: PMC3709531 DOI: 10.3332/ecancer.2013.333] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Indexed: 11/06/2022] Open
Abstract
The Third International Central Nervous System (CNS) Germ Cell Tumour (GCT) Symposium brought together over 100 delegates from all over the world to learn about the latest developments in these tumours and discuss future strategies for their management. Some areas of consensus were agreed upon, and controversies were discussed. Among these, the classification of GCTs and the surgical approach to their management were among the greatest areas of difference between different parts of the world. The need for radiotherapy (RT) as a part of standard first-line management for all malignant CNS GCTs was agreed, as well as the need for additional chemotherapy to maximise the cure in nongerminomatous malignant GCTs; the benefit of the addition of chemotherapy in localised germinoma to reduce the RT burden was also accepted as a good practice. The potential of biological parameters to assist the future diagnosis, treatment stratification, and disease monitoring for CNS GCTs was discussed. Such biological parameters may also represent targets for the development of novel therapies. The need for further collaboration between groups engaged in biological studies was agreed. The merits of proton beam RT were debated, and the importance of mitigating the long-term side effects of the treatment was underlined by a session on late effects.
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Affiliation(s)
- Matthew J Murray
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Murray MJ, Saini HK, Siegler CA, Hanning JE, Barker EM, van Dongen S, Ward DM, Raby KL, Groves IJ, Scarpini CG, Pett MR, Thornton CM, Enright AJ, Nicholson JC, Coleman N. LIN28 Expression in malignant germ cell tumors downregulates let-7 and increases oncogene levels. Cancer Res 2013; 73:4872-84. [PMID: 23774216 DOI: 10.1158/0008-5472.can-12-2085] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Despite their clinicopathologic heterogeneity, malignant germ cell tumors (GCT) share molecular abnormalities that are likely to be functionally important. In this study, we investigated the potential significance of downregulation of the let-7 family of tumor suppressor microRNAs in malignant GCTs. Microarray results from pediatric and adult samples (n = 45) showed that LIN28, the negative regulator of let-7 biogenesis, was abundant in malignant GCTs, regardless of patient age, tumor site, or histologic subtype. Indeed, a strong negative correlation existed between LIN28 and let-7 levels in specimens with matched datasets. Low let-7 levels were biologically significant, as the sequence complementary to the 2 to 7 nt common let-7 seed "GAGGUA" was enriched in the 3' untranslated regions of mRNAs upregulated in pediatric and adult malignant GCTs, compared with normal gonads (a mixture of germ cells and somatic cells). We identified 27 mRNA targets of let-7 that were upregulated in malignant GCT cells, confirming significant negative correlations with let-7 levels. Among 16 mRNAs examined in a largely independent set of specimens by quantitative reverse transcription PCR, we defined negative-associations with let-7e levels for six oncogenes, including MYCN, AURKB, CCNF, RRM2, MKI67, and C12orf5 (when including normal control tissues). Importantly, LIN28 depletion in malignant GCT cells restored let-7 levels and repressed all of these oncogenic let-7 mRNA targets, with LIN28 levels correlating with cell proliferation and MYCN levels. Conversely, ectopic expression of let-7e was sufficient to reduce proliferation and downregulate MYCN, AURKB, and LIN28, the latter via a double-negative feedback loop. We conclude that the LIN28/let-7 pathway has a critical pathobiologic role in malignant GCTs and therefore offers a promising target for therapeutic intervention.
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Affiliation(s)
- Matthew J Murray
- Department of Pathology, Cambridge University, Cambridge, United Kingdom.
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Calaminus G, Kortmann R, Worch J, Nicholson JC, Alapetite C, Garrè ML, Patte C, Ricardi U, Saran F, Frappaz D. SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease. Neuro Oncol 2013; 15:788-96. [PMID: 23460321 DOI: 10.1093/neuonc/not019] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [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: 11/13/2022] Open
Abstract
BACKGROUND We conducted a nonrandomized international study for intracranial germinoma that compared chemotherapy followed by local radiotherapy with reduced-dose craniospinal irradiation (CSI) alone, to determine whether the combined treatment regimen produced equivalent outcome and avoided irradiation beyond the primary tumor site(s). METHODS Patients with localized germinoma received either CSI or 2 courses of carboplatin and etoposide alternating with etoposide and ifosfamide, followed by local radiotherapy. Metastatic patients received CSI with focal boosts to primary tumor and metastatic sites, with the option to be preceded with chemotherapy. RESULTS Patients with localized germinoma (n = 190) received either CSI alone (n = 125) or combined therapy (n = 65), demonstrating no differences in 5-year event-free or overall survival, but a difference in progression-free survival (0.97 ± 0.02 vs 0.88 ± 0.04; P = .04). Seven of 65 patients receiving combined treatment experienced relapse (6 with ventricular recurrence outside the primary radiotherapy field), and only 4 of 125 patients treated with CSI alone experienced relapse (all at the primary tumor site). Metastatic patients (n = 45) had 0.98 ± 0.023 event-free and overall survival. CONCLUSIONS Localized germinoma can be treated with reduced dose CSI alone or with chemotherapy and reduced-field radiotherapy. The pattern of relapse suggests inclusion of ventricles in the radiation field. Reduced-dose craniospinal radiation alone is effective in metastatic disease.
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Affiliation(s)
- Gabriele Calaminus
- Department of Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany.
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Schönberger S, Okpanyi V, Calaminus G, Heikaus S, Leuschner I, Nicholson JC, Stoecklein NH, Schneider DT, Borkhardt A. EPCAM-A novel molecular target for the treatment of pediatric and adult germ cell tumors. Genes Chromosomes Cancer 2012; 52:24-32. [PMID: 22987628 DOI: 10.1002/gcc.22002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 07/31/2012] [Indexed: 01/06/2023] Open
Abstract
Germ cell tumors (GCTs) are thought to develop from totipotent primordial germ cells. Although the epithelial cell adhesion molecule (EPCAM) is expressed on embryonic stem cells as well as different tumor cells, it has not yet been extensively studied in GCTs. We analyzed EPCAM expression by quantitative RT-PCR in 48 fresh-frozen GCT specimens of different histology (10 mature teratoma, MT; 6 immature teratoma, IT; 7 dysgerminoma; 6 mixed malignant GCTs; 19 yolk sac tumor, YST) and in the GCT cell lines NCCIT, TE76.T, JAR and 2102Ep, and correlated its expression with AFP and hCG protein levels, histologic differentiation, and clinical follow-up data. EPCAM protein was visualized by immunohistochemistry of selected corresponding paraffin embedded tumor tissues. EPCAM was expressed in malignant but not in benign GCTs irrespective of age, sex, site and clinical stage of tumor (P = 0.001). In primary teratomas, EPCAM expression increased with their grade of immaturity (mean 2(-ΔCt) values: MT 0.23, IT 1.61, P = 0.007) and significantly correlated with serum AFP (P = 0.03) and hCG (P = 0.03) levels in malignant GCTs. Particularly high EPCAM levels were found in nonseminomatous GCTs such as YSTs (8.49) and choriocarcinoma (13.54). Immunohistochemical analysis verified gene expression data showing a distinct EPCAM staining in YST. Similarly in vitro, highest EPCAM expression was measured in GCT cell lines comprising yolk sac (2102Ep: 5.59) or choriocarcinoma (JAR: 10.65) components. This first comprehensive analysis of EPCAM in GCTs revealed high EPCAM expression in YSTs and choriocarcinomas. Thus, these nonseminomatous GCTs may be interesting targets for EPCAM immunotherapy, which has to be evaluated in further studies.
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Affiliation(s)
- Stefan Schönberger
- Department of Pediatric Hematology and Oncology, University of Bonn, University Children's Hospital Bonn, Germany.
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Shaw TJ, Pernar LI, Peyre SE, Helfrick JF, Vogelgesang KR, Graydon-Baker E, Chretien Y, Brown EJ, Nicholson JC, Heit JJ, Co JPT, Gandhi T. Impact of online education on intern behaviour around joint commission national patient safety goals: a randomised trial. BMJ Qual Saf 2012; 21:819-25. [PMID: 22706930 DOI: 10.1136/bmjqs-2011-000702] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To compare the effectiveness of two types of online learning methodologies for improving the patient-safety behaviours mandated in the Joint Commission National Patient Safety Goals (NPSG). METHODS This randomised controlled trial was conducted in 2010 at Massachusetts General Hospital and Brigham and Women's Hospital (BWH) in Boston USA. Incoming interns were randomised to either receive an online Spaced Education (SE) programme consisting of cases and questions that reinforce over time, or a programme consisting of an online slide show followed by a quiz (SQ). The outcome measures included NPSG-knowledge improvement, NPSG-compliant behaviours in a simulation scenario, self-reported confidence in safety and quality, programme acceptability and programme relevance. RESULTS Both online learning programmes improved knowledge retention. On four out of seven survey items measuring satisfaction and self-reported confidence, the proportion of SE interns responding positively was significantly higher (p<0.05) than the fraction of SQ interns. SE interns demonstrated a mean 4.79 (36.6%) NPSG-compliant behaviours (out of 13 total), while SQ interns completed a mean 4.17 (32.0%) (p=0.09). Among those in surgical fields, SE interns demonstrated a mean 5.67 (43.6%) NPSG-compliant behaviours, while SQ interns completed a mean 2.33 (17.9%) (p=0.015). Focus group data indicates that SE was more contextually relevant than SQ, and significantly more engaging. CONCLUSION While both online methodologies improved knowledge surrounding the NPSG, SE was more contextually relevant to trainees and was engaging. SE impacted more significantly on both self-reported confidence and the behaviour of surgical residents in a simulated scenario.
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Affiliation(s)
- Tim J Shaw
- Workforce Education and Development Group, K01, The University of Sydney, NSW 2006, Australia.
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Murray MJ, Fern LA, Stark DP, Eden TO, Nicholson JC. Breaking down barriers: improving outcomes for teenagers and young adults with germ cell tumours. Oncol Rev 2011. [DOI: 10.4081/95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Murray MJ, Fern LA, Stark DP, Eden TO, Nicholson JC. Breaking down barriers: improving outcomes for teenagers and young adults with germ cell tumours. Oncol Rev 2011. [DOI: 10.4081/oncol.2009.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Teenagers and young adults (TYA) with cancer have complex and evolving needs which are unique to this patient group. The TYA age-group have outcomes that are not improving over time, lagging behind both adult and children’s cancers in their rate of improvement in recent years...
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Jeyapalan JN, Noor DAM, Lee SH, Tan CL, Appleby VA, Kilday JP, Palmer RD, Schwalbe EC, Clifford SC, Walker DA, Murray MJ, Coleman N, Nicholson JC, Scotting PJ. Methylator phenotype of malignant germ cell tumours in children identifies strong candidates for chemotherapy resistance. Br J Cancer 2011; 105:575-85. [PMID: 21712824 PMCID: PMC3170957 DOI: 10.1038/bjc.2011.218] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 05/11/2011] [Accepted: 05/17/2011] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Yolk sac tumours (YSTs) and germinomas are the two major pure histological subtypes of germ cell tumours. To date, the role of DNA methylation in the aetiology of this class of tumour has only been analysed in adult testicular forms and with respect to only a few genes. METHODS A bank of paediatric tumours was analysed for global methylation of LINE-1 repeat elements and global methylation of regulatory elements using GoldenGate methylation arrays. RESULTS Both germinomas and YSTs exhibited significant global hypomethylation of LINE-1 elements. However, in germinomas, methylation of gene regulatory regions differed little from control samples, whereas YSTs exhibited increased methylation at a large proportion of the loci tested, showing a 'methylator' phenotype, including silencing of genes associated with Caspase-8-dependent apoptosis. Furthermore, we found that the methylator phenotype of YSTs was coincident with higher levels of expression of the DNA methyltransferase, DNA (cytosine-5)-methyltransferase 3B, suggesting a mechanism underlying the phenotype. CONCLUSION Epigenetic silencing of a large number of potential tumour suppressor genes in YSTs might explain why they exhibit a more aggressive natural history than germinomas and silencing of genes associated with Caspase-8-dependent cell death might explain the relative resistance of YSTs to conventional therapy.
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Affiliation(s)
- J N Jeyapalan
- Children's Brain Tumour Research Centre, Centre for Genetics and Genomics, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - D A Mohamed Noor
- Children's Brain Tumour Research Centre, Centre for Genetics and Genomics, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - S-H Lee
- Children's Brain Tumour Research Centre, Centre for Genetics and Genomics, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - C L Tan
- Children's Brain Tumour Research Centre, Centre for Genetics and Genomics, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - V A Appleby
- Children's Brain Tumour Research Centre, Centre for Genetics and Genomics, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - J P Kilday
- Children's Brain Tumour Research Centre, Child Health, School of Clinical Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - R D Palmer
- MRC Cancer Cell Unit, Hutchison/MRC Research Centre, Box 197, Hills Road, Cambridge CB2 0XZ, UK
| | - E C Schwalbe
- Northern Institute for Cancer Research, Sir James Spence Institute, Newcastle University, Newcastle-upon-Tyne NE2 4HH, UK
| | - S C Clifford
- Northern Institute for Cancer Research, Sir James Spence Institute, Newcastle University, Newcastle-upon-Tyne NE2 4HH, UK
| | - D A Walker
- Children's Brain Tumour Research Centre, Child Health, School of Clinical Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - M J Murray
- MRC Cancer Cell Unit, Hutchison/MRC Research Centre, Box 197, Hills Road, Cambridge CB2 0XZ, UK
| | - N Coleman
- MRC Cancer Cell Unit, Hutchison/MRC Research Centre, Box 197, Hills Road, Cambridge CB2 0XZ, UK
| | - J C Nicholson
- Department of Paediatric Oncology, Addenbrooke's Hospital, Box 181, Hills Road, Cambridge CB2 0QQ, UK
| | - P J Scotting
- Children's Brain Tumour Research Centre, Centre for Genetics and Genomics, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Abstract
α-Fetoprotein (AFP) measurements have clinical implications in fetal medicine and, in infants and older children, in detection, differential diagnosis and monitoring of malignant disease. Maternal serum AFP levels constitute part of a multiple-marker test used in early second-trimester screening to predict risk of fetal chromosomal abnormalities. Those individuals with increased risk are offered further definitive diagnostic investigation. Second-trimester screening is now increasingly being superseded by first-trimester screening with other serum markers and ultrasound. As AFP is only produced physiologically during fetal development, elevated serum levels after the first two post-natal years usually indicate the presence of a malignant disease process. Before this time, levels may be purely physiological and therefore serial values should be plotted on a logarithmic chart to ensure that they are falling appropriately, with a typical half-life of ∼5-6 days. If not, further investigation should be undertaken. Serum AFP is raised in a significant proportion of germ cell tumours (GCTs), hepatoblastoma and hepatocellular carcinoma (HCC). In suspected cases of GCT, serum human choriogonadotropin (HCG) estimation should also be performed. For possible intracranial GCTs, both serum and cerebrospinal fluid levels of AFP and HCG should be measured, ideally before neurosurgical biopsy. In malignant conditions, serum AFP may be used for diagnosis, treatment monitoring, surveillance for disease recurrence and prognostication. Immunohistochemistry for AFP using antibody staining is routinely used to assist pathological diagnosis on tissue sections where the differential includes GCT, hepatoblastoma and/or HCC. Elevations of serum AFP also occur in non-malignant conditions such as chronic liver disease.
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Affiliation(s)
- M J Murray
- Medical Research Council Cancer Cell Unit, Hutchison/MRC Research Centre, Cambridge, UK.
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Murray MJ, Metayer LE, Mallucci CL, Hale JP, Nicholson JC, Kirollos RW, Burke GAA. Intra-abdominal metastasis of an intracranial germinoma via ventriculo-peritoneal shunt in a 13-year-old female. Br J Neurosurg 2011; 25:747-9. [PMID: 21501064 DOI: 10.3109/02688697.2011.566383] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [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]
Abstract
A 13-year-old patient presented with massive intra-abdominal metastasis and spontaneous acute tumour lysis syndrome, 17-months after VP shunt placement for metastatic pineal germinoma treated with cranio-spinal-irradiation. Hyperhydration/rasburicase improved renal function, allowing chemotherapy with subsequent surgery. The patient remains event-free 34-months later. Risk of intra-abdominal metastasis from VP shunts is discussed.
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Affiliation(s)
- Matthew J Murray
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
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Okpanyi V, Schneider DT, Zahn S, Sievers S, Calaminus G, Nicholson JC, Palmer RD, Leuschner I, Borkhardt A, Schönberger S. Analysis of the adenomatous polyposis coli (APC) gene in childhood and adolescent germ cell tumors. Pediatr Blood Cancer 2011; 56:384-91. [PMID: 21225915 DOI: 10.1002/pbc.22669] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Accepted: 05/03/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Aberrant Wnt signaling due to deregulation of Wnt regulators is implicated in the development and progression of numerous embryonal tumors. This study addresses the questions if activation of Wnt signaling in germ cell tumors (GCTs) arising during childhood and adolescence is associated with aberrations of the tumor suppressor adenomatous polyposis coli (APC), and whether APC aberrations might be responsible for progression from benign teratoma to malignant yolk sac tumor (YST). PROCEDURE Forty-eight GCTs were analyzed, including mature (n = 5) and immature (n = 7) teratomas, mixed malignant GCTs (n = 10), YSTs (n = 17) as well as dysgerminomas (n = 9). To screen APC for genetic aberrations, we conducted direct sequencing of the mutation cluster region (MCR), loss of heterozygosity analyses (LOH) and protein truncation test. Epigenetic analyses included methylation specific PCR and bisulfite genomic sequencing of the APC 1a promoter. Gene expression was determined by quantitative real-time PCR. RESULTS Aberrant promoter methylation was detected in YSTs, teratomas and mixed malignant GCTs, with a pronounced hypermethylation exclusively in YSTs (11/13) while dysgerminomas were not methylated (0/9). Teratomas (2/2) and YSTs (4/5) show LOH at the APC locus. However, neither mutations within the MCR nor truncated protein were detected. APC expression did not significantly vary between the different histological subgroups. CONCLUSIONS Methylation of APC and LOH 5q21-22 in YSTs and teratomas provide evidence for involvement of APC in the accumulation of β-catenin and activation of the WNT pathway. Our additional analyses suggest that APC is unlikely to be solely responsible for the formation and progression of childhood GCTs.
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Affiliation(s)
- Vera Okpanyi
- University of Düsseldorf, Medical faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital Düsseldorf, D-40225 Dusseldorf, Germany
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