Neuroimaging and neuropsychological follow-up study in a pediatric brain tumor patient treated with surgery and radiation

Abstract Background MRI has shortcomings in differentiation between tumor tissue and post-therapeutic changes in pretreated brain tumor patients. Patients We assessed 22 static FET-PET/CT-scans of 17 pediatric patients (median age 12 years, range 2–16 years, ependymoma n=4, medulloblastoma n=4, low-grade glioma n=6, high-grade glioma n=3, germ cell tumor n=1, choroid plexus tumor n=1, median follow-up: 112 months) with multimodal treatment. Method FET-PET/CT-scans were analyzed visually by 3 independent nuclear medicine physicians. Additionally quantitative FET-Uptake for each lesion was determined by calculating standardized uptake values (SUVmaxT/SUVmeanB, SUVmeanT/SUVmeanB). Histology or clinical follow-up served as reference. Results Static FET-PET/CT reliably distinguished between tumor tissue and post-therapeutic changes in 16 out of 17 patients. It identified correctly vital tumor tissue in 13 patients and post-therapeutic changes in 3 patients. SUV-based analyses were less sensitive than visual analyses. Except from a choroid plexus carcinoma, all tumor entities showed increased FET-uptake. Discussion Our study comprises a limited number of patients but results corroborate the ability of FET to detect different brain tumor entities in pediatric patients and discriminate between residual/recurrent tumor and post-therapeutic changes. Conclusions We observed a clear benefit from additional static FET-PET/CT-scans when conventional MRI identified equivocal lesions in pretreated pediatric brain tumor patients. These results warrant prospective studies that should include dynamic scans.

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Improved neuropsychological outcomes following proton therapy relative to X-ray therapy for pediatric brain tumor patients

Neuro-Oncology ◽

10.1093/neuonc/noz070 ◽

2019 ◽

Vol 21 (7) ◽

pp. 934-943 ◽

Cited By ~ 18

Author(s):

Jeffrey P Gross ◽

Stephanie Powell ◽

Frank Zelko ◽

William Hartsell ◽

Stewart Goldman ◽

...

Keyword(s):

Brain Tumor ◽

Processing Speed ◽

Adaptive Functioning ◽

Pediatric Brain Tumor ◽

Neuropsychological Evaluation ◽

Tumor Patients ◽

X Ray ◽

Neuropsychological Outcomes ◽

Pediatric Brain

AbstractBackgroundSurvivors of pediatric brain tumors are at risk for impaired development in multiple neuropsychological domains. The purpose of this study was to compare neuropsychological outcomes of pediatric brain tumor patients who underwent X-ray radiotherapy (XRT) versus proton radiotherapy (PRT).MethodsPediatric patients who underwent either XRT or PRT and received posttreatment age-appropriate neuropsychological evaluation—including measures of intelligence (IQ), attention, memory, visuographic skills, academic skills, and parent-reported adaptive functioning—were identified. Multivariate analyses were performed to assess differences in neuropsychological outcomes and included tests for interaction between treatment cohort and follow-up time.ResultsBetween 1998 and 2017, 125 patients with tumors located in the supratentorial (17.6%), midline (28.8%), or posterior fossa (53.6%) compartments received radiation and had posttreatment neuropsychological evaluation. Median age at treatment was 7.4 years. The PRT patient cohort had higher estimated SES and shorter median time from radiotherapy completion to last neuropsychological evaluation (6.7 vs 2.6 y, P < 0.001). On multivariable analysis, PRT was associated with higher full-scale IQ (β = 10.6, P = 0.048) and processing speed (β = 14.4, P = 0.007) relative to XRT, with trend toward higher verbal IQ (β = 9.9, P = 0.06) and general adaptive functioning (β = 11.4, P = 0.07). Planned sensitivity analyses truncating follow-up interval in the XRT cohort re-demonstrated higher verbal IQ (P = 0.01) and IQ (P = 0.04) following PRT, with trend toward improved processing speed (P = 0.09).ConclusionsPRT is associated with favorable outcomes for intelligence and processing speed. Combined with other strategies for treatment de-intensification, PRT may further reduce neuropsychological morbidity of brain tumor treatment.

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Feasibility and efficacy of an extended trial of home-based working memory training for pediatric brain tumor survivors: a pilot study

Neuro-Oncology Practice ◽

10.1093/nop/npw015 ◽

2016 ◽

Vol 4 (2) ◽

pp. 111-120 ◽

Cited By ~ 3

Author(s):

Bonnie Carlson-Green ◽

Jennifer Puig ◽

Anne Bendel

Keyword(s):

Working Memory ◽

Brain Tumor ◽

Executive Functioning ◽

Late Effects ◽

Pediatric Brain Tumor ◽

Working Memory Training ◽

Memory Training ◽

Neurocognitive Late Effects ◽

Pediatric Brain

Abstract Background. Impaired working memory appears to play a key role in some of the neurocognitive late effects of pediatric brain tumor treatments, including declines in intellectual and executive functioning. Recent studies of pediatric cancer survivors suggest Cogmed® Working Memory Training is effective at improving working memory, although pediatric brain tumor survivors may demonstrate a less robust response than children with other cancers. The current study sought to determine if an extended course of Cogmed (35 sessions) was both feasible and efficacious for brain tumor survivors and if improvements were observable in near-transfer and far-transfer working memory measures as well as parent rating scores at 6 months post-treatment. Methods. Twenty pediatric brain tumor survivors ages 8 to 18 years with working memory deficits completed 35 sessions of Cogmed. Assessments of working memory and academic skills were completed at baseline, completion of training, and 6-month follow-up and parents completed questionnaires at baseline and 6-month follow-up. Results. Participants showed significant improvements in working memory at training completion and 6-month follow-up and math achievement at 6-month follow-up. Parents reported executive functioning improvements at follow-up as compared with baseline. Participants’ program-based working memory skills did not change significantly between sessions 25 and 35, suggesting that extended training did not provide additional benefit. Conclusions. This study replicates and extends previous research by: (1) demonstrating that brain tumor survivors at high risk for neurocognitive late effects can complete and benefit from working memory training, (2) identifying a point of diminished returns on training time investment, and (3) demonstrating benefits 6 months post-intervention.

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Predictors of cognitive function in pediatric brain tumor patients: pre-surgery through 24-month follow-up

Applied Neuropsychology Child ◽

10.1080/21622965.2019.1706179 ◽

2019 ◽

pp. 1-8

Author(s):

Claire E. Fraley ◽

Jennifer C. Thigpen ◽

Matthew M. Pearson ◽

John F. Kuttesch ◽

Leandra Desjardins ◽

...

Keyword(s):

Brain Tumor ◽

Cognitive Function ◽

Pediatric Brain Tumor ◽

Tumor Patients ◽

Pediatric Brain

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Peripheral circulation miRNA expression of pediatric brain tumors and its relation to tumor miRNA expression levels

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.2.peds19715 ◽

2020 ◽

Vol 26 (2) ◽

pp. 136-144 ◽

Cited By ~ 1

Author(s):

Markus Bookland ◽

Eileen Gillan ◽

Xianyuan Song ◽

Antonina Kolmakova

Keyword(s):

Brain Tumor ◽

Brain Tumors ◽

Mirna Expression ◽

Tumor Tissue ◽

Pediatric Brain Tumor ◽

Pediatric Brain Tumors ◽

Tumor Patients ◽

Tumor Patient ◽

Serum Mirna ◽

Pediatric Brain

OBJECTIVEMicro RNAs (miRNAs) in peripheral biofluids (e.g., blood, saliva, urine) have been investigated as potential sources of diagnostic and prognostic information for a variety of tumor types, including pediatric brain tumors. While significant predictive associations have been identified between unique serum miRNA concentrations and some pediatric brain tumors, it is unclear whether serum miRNA abnormalities in pediatric brain tumor patients are representative of miRNA alterations in the tumor tissue compartment or whether they represent host tissue reactions to the presence of a brain tumor. The authors sought to identify whether serum miRNA changes in pediatric brain tumor patient sera could be explained by miRNA alterations within their tumors.METHODSMatched serum and tissue samples were taken from a cohort of pediatric brain tumor patients (juvenile pilocytic astrocytoma [JPA] = 3, medulloblastoma = 4, ependymoma = 3), and unmatched control samples (n = 5) were acquired from control pediatric patients without oncological diagnoses. Extracted RNAs were tested within an array of 84 miRNAs previously noted to be relevant in a variety of brain tumors.RESULTSmiR-26a-5p correlated strongly in JPA patients within both the serum and tumor tissue samples (R2 = 0.951, p = 0.046), and serum levels were highly predictive of JPA (area under the curve = 0.751, p = 0.027). No other miRNAs that were significantly correlated between biological compartments were significantly associated with brain tumor type. In total, 15 of 84 tested miRNAs in JPA patients, 14 of 84 tested miRNAs in ependymoma patients, and 4 of 84 tested miRNAs in medulloblastoma patients were significantly, positively correlated between serum and tumor tissue compartments (R2 > 0.950, p < 0.05).CONCLUSIONSThe majority of miRNA changes in pediatric brain tumor patient sera that are significantly associated with the presence of a brain tumor do not correlate with brain tumor miRNA expression levels. This suggests that peripheral miRNA changes within pediatric brain tumor patients likely derive from tissues other than the tumors themselves.

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Follow‐up evaluation of a web‐based pediatric brain tumor board in Latin America

Pediatric Blood & Cancer ◽

10.1002/pbc.29073 ◽

2021 ◽

Author(s):

Mariel Rosabal‐Obando ◽

Diana S. Osorio ◽

Alvaro Lassaletta ◽

Andrés Morales La Madrid ◽

Ute Bartels ◽

...

Keyword(s):

Latin America ◽

Brain Tumor ◽

Pediatric Brain Tumor ◽

Tumor Board ◽

Web Based ◽

Pediatric Brain

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Hyperacute Infarct on Intraoperative Diffusion Imaging of Pediatric Brain Tumor Surgery

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.226 ◽

2019 ◽

Vol 46 (5) ◽

pp. 550-558 ◽

Cited By ~ 1

Author(s):

Christine Saint-Martin ◽

Sergio Apuzzo ◽

Ayat Salman ◽

Jean-Pierre Farmer

Keyword(s):

Brain Tumor ◽

Brain Area ◽

Tumor Resection ◽

Pediatric Brain Tumor ◽

Intraoperative Mri ◽

Control Group ◽

Post Surgery ◽

Brain Tumor Resection ◽

Pediatric Brain

ABSTRACT:Background:Brain neoplasms are the second-most prevalent cancer of childhood for which surgical resection remains the main treatment. Intraoperative MRI is a useful tool to optimize brain tumor resection. It is, however, not known whether intraoperative MRI can detect complications such as hyperacute ischemic infarcts.Methods:A retrospective analysis of pre- and intraoperative MRIs including DWI sequence and correlation with early and 3-month postoperative MRIs was conducted to evaluate the incidence of hyperacute arterial infarct during pediatric brain tumor resection. Patient demographics, pathological type, tumor location, resection type as well as preoperative tumoral vessel encasement, evolution of the area of restricted diffusion were collected and analyzed comparatively between the group with acute infarct and the control group. Extent of the hyperacute infarct was compared to both early postsurgical and 3-month follow-up MRIs.Results:Of the 115 cases, 13 (11%) developed a hyperacute arterial ischemic infarct during brain tumor resection. Tumoral encasement of vessels was more frequent in the infarct group (69%) compared to 25.5% in the control group. Four cases showed additional vessel irregularities on intraoperative MRI. On early follow-up, the infarcted brain area had further progressed in six cases and was stable in seven cases. No further progression was noted after the first week post-surgery.Conclusions:Hyperacute infarcts are not rare events to complicate pediatric brain tumor resection. Tumoral encasement of the circle of Willis vessels appears to be the main risk factor. Intraoperative DWI underestimates the final extent of infarcted tissue compared to early postsurgical MRI.

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