Conference Watch
39th Annual Conference of the International Society of Paediatric Oncology; Oct 31–Nov 3, 2007; Mumbai, India Liver cancers no longer different Children with fibrolamellar hepatocarcinoma (FHC) and conventional hepatocellular carcinoma (HCC) have similar long-term outcomes despite previous evidence suggesting otherwise, according to a multinational group of researchers. Daniel Aronson (Emma Childrens Hospital, Amsterdam, Netherlands) and colleagues centrally reviewed the records of 65 children previously enrolled in the SIOPEL2 and SIOPEL3 trials. 24 children had FHC compared with 41 with HCC. Although differences were noted in patient demographics, treatments used, and early response, overall survival plateaued at about 20–25% at 2·5 years for HCC and at 4 years for FHC. A multivariate analysis showed no relation between overall survival and histology, and a lack of complete resection and the presence of metastases were determinants of disease progression.
New regimen for brain tumours A study has shown that a single course of cyclophosphamide (1500 mg/m2 per day for 4 days) followed by melphalan (60 mg/m2 per day for 3 days) plus autologous hematopoietic stem-cell transplantation is a promising regimen for patients with recurrent medulloblastoma or intracranial germinoma. Richard Kadota (University of California, San Diego, CA, USA) and colleagues treated 29 children who had
undergone no more than one primary treatment protocol and one round of salvage treatment for recurrent disease with the experimental regimen and noted 18 patients had either a complete response (n=5) or a cytogenetic complete response (n=13). Additionally, nine children had longterm progression-free survival (8 years’ median follow-up).
Contaminated stem cells Researchers in the Netherlands (Janine Stutterheim and co-workers, Emma Childrens Hospital, Amsterdam) have discovered that stem-cell harvests from patients with high-risk neuroblastoma that contain tumoural mRNA significantly increased the risk of disease recurrence in the recipient. Minimum residual disease in autologous stem-cell harvests from peripheral blood or bone marrow was measured using quantitative real-time PCR of five neuroblastoma markers. 22 harvests were noted to contain tumoral mRNA and 86% (19/22) of patients who received mRNA-positive stem cells died of their disease compared with 49% (19/39) of patients who received mRNAnegative transplants. This finding translated into a significant difference in 5-year overall survival between the two groups of patients in favour of mRNA-negative stem-cell transplants (11% vs 49%).
IMRT for retinoblastoma Intensity-modulated radiotherapy (IMRT) is an effective treatment for retinoblastoma, say American collaborators. Retinoblastoma is the most common intraocular tumour in children and chemotherapy followed by radiotherapy is the standard treatment. Use of IMRT instead of conventional radiotherapy, however, has not been reported. Hadi Zahra (Baylor College of Medicine, Houston, TX, USA) and http://oncology.thelancet.com Vol 8 December 2007
co-workers treated five children with IMRT after chemoreduction (two patients received treatment for bilateral disease). A median dose of 43·9 Gy was given over 4–4·5 weeks and all patients had progressive or recurrent disease after their initial chemotherapy or other cytoablative treatments. After a median follow-up of 32 months, five of seven treated eyes had no evidence of disease, two patients had developed new intraretinal tumours, and one had orbital hypoplasia. There were no secondary tumours or other complications.
New treatment for ATRT-CNS A German pilot study involving 22 children with atypical teratoid/ rhabdoid tumour of the central nervous system (ATRT-CNS) has shown a new anthracycline-basedchemotherapyregimen to be effective, albeit accompanied with substantial toxic effects. Overall survival for children with ATRT-CNS is less than 12 months and Ove Peters (University of Regensburg, Germany) and colleagues devised a new treatment protocol on the basis of outcomes seen in historical national data and in an international meta-analysis. The regimen consisted of two cycles of induction chemotherapy (doxorubicin, dactinomycin, cisplatin, vincristine, and methotrexate); chemoradiotherapy with carboplatin and 54 Gy of radiation; reinduction chemotherapy (using the same drugs as induction chemotherapy); and consolidation chemotherapy (CCNU, cisplatin, vincristine, and methotrexate). Of the 19 children who completed the protocol, event-free survival and overall survival after a median follow-up of 44 months was 77% and 81%, respectively. Grade 3–4 mucositis and infection was noted in 48% and 40% of patients, respectively.
David Collingridge 1063
39th Annual Conference of the International Society of Paediatric Oncology; Oct 31–Nov 3, 2007; Mumbai, India Liver cancers no longer different Children with fibrolamellar hepatocarcinoma (FHC) and conventional hepatocellular carcinoma (HCC) have similar long-term outcomes despite previous evidence suggesting otherwise, according to a multinational group of researchers. Daniel Aronson (Emma Childrens Hospital, Amsterdam, Netherlands) and colleagues centrally reviewed the records of 65 children previously enrolled in the SIOPEL2 and SIOPEL3 trials. 24 children had FHC compared with 41 with HCC. Although differences were noted in patient demographics, treatments used, and early response, overall survival plateaued at about 20–25% at 2·5 years for HCC and at 4 years for FHC. A multivariate analysis showed no relation between overall survival and histology, and a lack of complete resection and the presence of metastases were determinants of disease progression.
New regimen for brain tumours A study has shown that a single course of cyclophosphamide (1500 mg/m2 per day for 4 days) followed by melphalan (60 mg/m2 per day for 3 days) plus autologous hematopoietic stem-cell transplantation is a promising regimen for patients with recurrent medulloblastoma or intracranial germinoma. Richard Kadota (University of California, San Diego, CA, USA) and colleagues treated 29 children who had
undergone no more than one primary treatment protocol and one round of salvage treatment for recurrent disease with the experimental regimen and noted 18 patients had either a complete response (n=5) or a cytogenetic complete response (n=13). Additionally, nine children had longterm progression-free survival (8 years’ median follow-up).
Contaminated stem cells Researchers in the Netherlands (Janine Stutterheim and co-workers, Emma Childrens Hospital, Amsterdam) have discovered that stem-cell harvests from patients with high-risk neuroblastoma that contain tumoural mRNA significantly increased the risk of disease recurrence in the recipient. Minimum residual disease in autologous stem-cell harvests from peripheral blood or bone marrow was measured using quantitative real-time PCR of five neuroblastoma markers. 22 harvests were noted to contain tumoral mRNA and 86% (19/22) of patients who received mRNA-positive stem cells died of their disease compared with 49% (19/39) of patients who received mRNAnegative transplants. This finding translated into a significant difference in 5-year overall survival between the two groups of patients in favour of mRNA-negative stem-cell transplants (11% vs 49%).
IMRT for retinoblastoma Intensity-modulated radiotherapy (IMRT) is an effective treatment for retinoblastoma, say American collaborators. Retinoblastoma is the most common intraocular tumour in children and chemotherapy followed by radiotherapy is the standard treatment. Use of IMRT instead of conventional radiotherapy, however, has not been reported. Hadi Zahra (Baylor College of Medicine, Houston, TX, USA) and http://oncology.thelancet.com Vol 8 December 2007
co-workers treated five children with IMRT after chemoreduction (two patients received treatment for bilateral disease). A median dose of 43·9 Gy was given over 4–4·5 weeks and all patients had progressive or recurrent disease after their initial chemotherapy or other cytoablative treatments. After a median follow-up of 32 months, five of seven treated eyes had no evidence of disease, two patients had developed new intraretinal tumours, and one had orbital hypoplasia. There were no secondary tumours or other complications.
New treatment for ATRT-CNS A German pilot study involving 22 children with atypical teratoid/ rhabdoid tumour of the central nervous system (ATRT-CNS) has shown a new anthracycline-basedchemotherapyregimen to be effective, albeit accompanied with substantial toxic effects. Overall survival for children with ATRT-CNS is less than 12 months and Ove Peters (University of Regensburg, Germany) and colleagues devised a new treatment protocol on the basis of outcomes seen in historical national data and in an international meta-analysis. The regimen consisted of two cycles of induction chemotherapy (doxorubicin, dactinomycin, cisplatin, vincristine, and methotrexate); chemoradiotherapy with carboplatin and 54 Gy of radiation; reinduction chemotherapy (using the same drugs as induction chemotherapy); and consolidation chemotherapy (CCNU, cisplatin, vincristine, and methotrexate). Of the 19 children who completed the protocol, event-free survival and overall survival after a median follow-up of 44 months was 77% and 81%, respectively. Grade 3–4 mucositis and infection was noted in 48% and 40% of patients, respectively.
David Collingridge 1063
