The surgical treatment of paediatric thalamic gliomas has been burdened with high morbidity, and these lesions were often considered inoperable. With new approaches and intraoperative technologies, we can remove tumours once deemed inoperable. In our single centre, we have operated on 11 paediatric patients over the course of 8 years. We have performed eight GTR resections and three intended subtotal resections. The postoperative neurological deficit ranged from mild to very severe for motor weakness and none to severe for aphasia after surgery, with all of the patients improving at 3-month follow-up. Radicality in the surgical approach to thalamic gliomas in children has shown significant benefits when compared to more conservative approaches. For children with LGGs, extensive surgical resection is associated with improved prognosis and longer progression-free survival. However, it does not yield the same proportional benefit for HGGs due to its aggressive nature and worse outlook.
- Publikační typ
- časopisecké články MeSH
Rhabdoid tumors are aggressive tumors that may arise in the kidney, soft tissue, central nervous system, or other organs. They are defined by SMARCB1 (INI1) or SMARCA4 alterations. Often, very young children are affected, and the prognosis is dismal. Four patients with primary atypical teratoid rhabdoid tumor (AT/RT, a rhabdoid tumor in the central nervous system) were treated by resection and high dose chemotherapy. Tazemetostat was introduced after completion of chemotherapy. Three patients have achieved an event free survival of 32, 34, and 30 months respectively. One progressed and died. His overall survival was 20 months. One patient was treated for a relapsed atypical teratoid rhabdoid tumor. The treatment combined metronomic therapy, radiotherapy, tazemetostat and immunotherapy. This patient died of disease progression, with an overall survival of 37 months. One patient was treated for a rhabdoid tumor of the ovary. Tazemetostat was given as maintenance after resection, chemotherapy, and radiotherapy, concomitantly with immunotherapy. Her event free survival is 44 months. Only approximately 40% of patients with rhabdoid tumors achieve long-term survival. Nearly all relapses occur within two years from diagnosis. The event free survival of four of the six patients in our cohort has exceeded this timepoint. Tazemetostat has been mostly tested as a single agent in the relapsed setting. We present promising results when applied as maintenance or add on in the first line treatment.
- MeSH
- dítě MeSH
- DNA-helikasy MeSH
- gen SMARCB1 MeSH
- jaderné proteiny MeSH
- kojenec MeSH
- lidé MeSH
- lokální recidiva nádoru farmakoterapie MeSH
- nádory centrálního nervového systému * patologie MeSH
- předškolní dítě MeSH
- rhabdoidní nádor * farmakoterapie patologie MeSH
- teratom * patologie MeSH
- transkripční faktory MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
V této kazuistice popisujeme pediatrického pacienta s výskytem vzácného spinálního tumoru, který byl akutně resekován s inoperabilním reziduem. Histologie prokázala ektopický adenom adrenokortikálního typu manifestující se jak neurologickými příznaky z útlaku míchy, tak i endokrinologickými, z důvodu nadprodukce pohlavních hormonů spojených s předčasnou pseudopubertou a urychleným růstem. Pomocí CT a celotělového PET/MRI vyšetřování nebylo nalezeno žádné další ložisko tumoru. Nejednalo se o sporadický výskyt, pacient zdědil patologickou alelu genu pro protein TP53 - Li-Fraumeni syndrom po otcově linii, kde byl zvýšený výskyt malignit v brzkém věku. Pacient je nyní již rok sledován dle standardů pro Li-Fraumeni syndrom. V případě progrese a při pochybnostech o hranici adenom/karcinom bude adjuvantní léčba stavěna na imunoterapii na základě zvýšené exprese PD-L1 prokázané pomocí imunohistochemie.
The aim of this article is to describe a case of the infrequent spinal adenoma in paediatric patient. This adenoma was resected with inoperable residuum and histology confirmed an extremely rare spinal adrenocortical adenoma. Tumor was was presented by symptoms of spinal compression and endocrinological signs of pseudopubertas praecox. There was not any other lesion found via PET/MRI examination. Tumor was not accidental, patient inherited pathological allele of the gene coding TP53 protein from the father line, where was frequent occurrence of malignancies in early age. Understanding principles of Li-Fraumeni syndrome is crucial to assess the effective follow-up. In case of future progression with malignant transformation, we plan to use the immunotherapy to target high expression of PD-L1 proved by immunohistochemistry.
- MeSH
- adenom kůry nadledvin diagnóza komplikace patologie terapie MeSH
- anamnéza MeSH
- dítě MeSH
- lidé MeSH
- Liův-Fraumeniho syndrom * komplikace MeSH
- nádory páteře * diagnóza etiologie patologie MeSH
- nádory klasifikace komplikace prevence a kontrola MeSH
- předčasná puberta etiologie MeSH
- věkové faktory MeSH
- vzácné nemoci diagnóza etiologie patologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
Východiska: Nádorový genom dětských pacientů se vyznačuje řadou charakteristik, které jej značně odlišují od malignit dospělého věku. Mezi tyto charakteristiky patří nízká mutační nálož, významná role epigenetických změn a také četnost výskytu fúzních genů jakožto řídicích prvků kancerogeneze. Fúzní geny vznikají v důsledku několika typů chromozomálních přestaveb, jako jsou translokace, delece, inzerce či inverze, a mohou mít celou řadu funkčních dopadů. Ačkoli byly v minulosti studovány především v kontextu hematologických malignit, jejich význam v diagnostice a terapii solidních nádorů neustále narůstá. Materiál a metody: U 250 pacientů se solidními nádory z Kliniky dětské onkologie Fakultní nemocnice Brno byla provedena analýza fúzních genů metodou cíleného RNA sekvenování. Sekvenační knihovny byly připraveny s pomocí sady TruSight RNA Pan-Cancer Panel (Illumina, USA), který pokrývá 1385 klinicky relevantních genů. Sekvenace knihoven proběhla s využitím NextSeq Mid Output Kit (150 cyklů) na platformě NextSeq 500 (Illumina, USA). Sekvenační čtení byla namapována na referenční genom hg38 s pomocí STAR aligneru s parametry nastavenými tak, aby umožnily detekci fúzních genů. Pro vyhledání fúzních genů byly použity nástroje Arriba a STARfusion a identifikované fúzní geny byly manuálně ověřeny v softwaru IGV. Výsledky: Klinicky relevantní fúzní geny byly identifikovány u 25 % pacientů. Největší podíl identifikovaných fúzí tvořily fúze asociované se sarkomy, jako jsou EWSR1-FLI1, PAX3-FOXO1 nebo SS18-SSX1/2. Druhou největší skupinu představovaly fúze typické pro nádory CNS, zejména KIAA1549-BRAF či jiné fúze aktivující Ras/MAPK signalizaci. U pacientky s renálním karcinomem byla identifikována dosud nepopsaná fúze DVL3-TFE3. Celkem 33 % identifikovaných fúzních genů bylo terapeuticky cílitelných a u 2/3 pacientů s terapeuticky cílitelnou fúzí byla nasazena odpovídající léčba. Závěr: Analýza fúzních genů má velký přínos v diagnostice, prognostické stratifikaci a terapeutickém plánování pediatrických onkologických pacientů. Použití vysokokapacitních přístupů, jako je RNA sekvenování, umožňuje identifikaci nových fúzních genů a tím také hlubší porozumění komplexním změnám doprovázejícím vznik a rozvoj nádorových onemocnění.
Background: Pediatric cancer genome significantly differs from the genome of adult malignancies and is characterized by low tumor mutational burden, the great importance of epigenetic changes, and also the frequent occurrence of fusion genes. Fusion genes arise as a result of several types of chromosomal rearrangements, such as translocations, deletions, insertions, or inversions, and can have a variety of functional impacts. In the past, they were studied mainly in the context of hematological malignancies; however, their importance in the diagnostics and therapy of solid tumors is increasing. Materials and methods: In 250 patients with solid tumors from the Department of Pediatric Oncology of University Hospital Brno, an analysis of fusion genes was performed using targeted RNA sequencing. Sequencing libraries were prepared using the TruSight RNA Pan-Cancer Panel (Illumina), which covers 1 385 clinically relevant genes, and sequenced using the NextSeq Mid Output Kit (150 cycles) on the NextSeq 500 platform (Illumina). Sequencing reads were mapped to hg38 using the STAR aligner with parameters set to allow fusion genes detection. Arriba and STARfusion tools were used to search for fusion genes, which were subsequently manually verified in the IGV software. Results: Clinically relevant fusion genes were identified in 25% of patients. The largest proportion of fusions identified were fusions associated with sarcomas, such as EWSR1-FLI1, PAX3-FOXO1, or SS18-SSX1/2. The second-largest group was represented by CNS tumor fusions, especially KIAA1549-BRAF or other Ras/MAPK-associated fusions. A previously undescribed DVL3-TFE3 fusion was identified in a renal carcinoma patient. 33% of the identified fusion genes were therapeutically targetable, and 2/3 of patients received corresponding treatment. Conclusion: The analysis of fusion genes is of great benefit in the diagnostics, prognostic stratification, and therapeutic planning of pediatric cancer patients. The use of high-throughput approaches such as RNA sequencing enables the identification of novel fusion genes as well as a deeper understanding of the complex changes that are involved in the development of the disease.
- Publikační typ
- abstrakt z konference MeSH
Background: The use of liquid biopsy is of potential high importance for children with high grade (HGG) and diffuse midline gliomas (DMG), particularly where surgical procedures are limited, and invasive biopsy sampling not without risk. To date, however, the evidence that detection of cell-free DNA (cfDNA) or circulating tumor DNA (ctDNA) could provide useful information for these patients has been limited, or contradictory. Methods: We optimized droplet digital PCR (ddPCR) assays for the detection of common somatic mutations observed in pediatric HGG/DMG, and applied them to liquid biopsies from plasma, serum, cerebrospinal fluid (CSF), and cystic fluid collected from 32 patients. Results: Although detectable in all biomaterial types, ctDNA presented at significantly higher levels in CSF compared to plasma and/or serum. When applied to a cohort of 127 plasma specimens from 41 patients collected from 2011 to 2018 as part of a randomized clinical trial in pediatric non-brainstem HGG/DMG, ctDNA profiling by ddPCR was of limited use due to the small volumes (mean = 0.49 mL) available. In anecdotal cases where sufficient material was available, cfDNA concentration correlated with disease progression in two examples each of poor response in H3F3A_K27M-mutant DMG, and longer survival times in hemispheric BRAF_V600E-mutant cases. Conclusion: Tumor-specific DNA alterations are more readily detected in CSF than plasma. Although we demonstrate the potential of the approach to assessing tumor burden, our results highlight the necessity for adequate sample collection and approach to improve detection if plasma samples are to be used.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
PURPOSE: Children with pediatric gliomas harboring a BRAF V600E mutation have poor outcomes with current chemoradiotherapy strategies. Our aim was to study the role of targeted BRAF inhibition in these tumors. PATIENTS AND METHODS: We collected clinical, imaging, molecular, and outcome information from patients with BRAF V600E-mutated glioma treated with BRAF inhibition across 29 centers from multiple countries. RESULTS: Sixty-seven patients were treated with BRAF inhibition (pediatric low-grade gliomas [PLGGs], n = 56; pediatric high-grade gliomas [PHGGs], n = 11) for up to 5.6 years. Objective responses were observed in 80% of PLGGs, compared with 28% observed with conventional chemotherapy (P < .001). These responses were rapid (median, 4 months) and sustained in 86% of tumors up to 5 years while receiving therapy. After discontinuation of BRAF inhibition, 76.5% (13 of 17) of patients with PLGG experienced rapid progression (median, 2.3 months). However, upon rechallenge with BRAF inhibition, 90% achieved an objective response. Poor prognostic factors in conventional therapies, such as concomitant homozygous deletion of CDKN2A, were not associated with lack of response to BRAF inhibition. In contrast, only 36% of those with PHGG responded to BRAF inhibition, with all but one tumor progressing within 18 months. In PLGG, responses translated to 3-year progression-free survival of 49.6% (95% CI, 35.3% to 69.5%) versus 29.8% (95% CI, 20% to 44.4%) for BRAF inhibition versus chemotherapy, respectively (P = .02). CONCLUSION: Use of BRAF inhibition results in robust and durable responses in BRAF V600E-mutated PLGG. Prospective studies are required to determine long-term survival and functional outcomes with BRAF inhibitor therapy in childhood gliomas.
- Publikační typ
- časopisecké články MeSH
