25 results on '"Valteau-Couanet, D."'
Search Results
2. A subset of image-defined risk factors predict completeness of resection in children with high-risk neuroblastoma: An international multicenter study.
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Espinoza AF, Bagatell R, McHugh K, Naranjo AH, Van Ryn C, Rojas Y, Lyons K, Guillerman RP, Kirby C, Brock P, Volchenboum S, Simon T, States L, Miller A, Krug B, Sarnacki S, Irtan S, Brisse HJ, Valteau-Couanet D, von Schweinitz D, Kammer B, Granata C, Pio L, Park JR, and Nuchtern JG
- Subjects
- Humans, Male, Female, Child, Preschool, Child, Infant, Risk Factors, Adolescent, Survival Rate, Prognosis, Follow-Up Studies, Infant, Newborn, Retrospective Studies, Neuroblastoma surgery, Neuroblastoma pathology, Neuroblastoma mortality, Neuroblastoma diagnostic imaging
- Abstract
Background: Image-defined risk factors (IDRFs) were promulgated for predicting the feasibility and safety of complete primary tumor resection in children with neuroblastoma (NB). There is limited understanding of the impact of individual IDRFs on resectability of the primary tumor or patient outcomes. A multicenter database of patients with high-risk NB was interrogated to answer this question., Design/methods: Patients with high-risk NB (age <20 years) were eligible if cross-sectional imaging was performed at least twice prior to resection. IDRFs and primary tumor measurements were recorded for each imaging study. Extent of resection was determined from operative reports., Results: There were 211 of 229 patients with IDRFs at diagnosis, and 171 patients with IDRFs present pre-surgery. A ≥90% resection was significantly more likely in the absence of tumor invading or encasing the porta hepatis, hepatoduodenal ligament, superior mesenteric artery (SMA), renal pedicles, abdominal aorta/inferior vena cava (IVC), iliac vessels, and/or diaphragm at diagnosis or an overlapping subset of IDRFs (except diaphragm) at pre-surgery. There were no significant differences in event-free survival (EFS) and overall survival (OS) when patients were stratified by the presence versus absence of any IDRF either at diagnosis or pre-surgery., Conclusion: Two distinct but overlapping subsets of IDRFs present either at diagnosis or after induction chemotherapy significantly influence the probability of a complete resection in children with high-risk NB. The presence of IDRFs was not associated with significant differences in OS or EFS in this cohort., (© 2024 Wiley Periodicals LLC.)
- Published
- 2024
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3. Phase II study of 131 I-metaiodobenzylguanidine with 5 days of topotecan for refractory or relapsed neuroblastoma: Results of the French study MIITOP.
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Sevrin F, Kolesnikov-Gauthier H, Cougnenc O, Bogart E, Schleiermacher G, Courbon F, Gambart M, Giraudet AL, Corradini N, Badel JN, Rault E, Oudoux A, Deley MCL, Valteau-Couanet D, and Defachelles AS
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- Adolescent, Child, Child, Preschool, Humans, Young Adult, 3-Iodobenzylguanidine adverse effects, Busulfan therapeutic use, Chronic Disease, Melphalan, Neoplasm Recurrence, Local drug therapy, Neuroblastoma drug therapy, Neuroblastoma radiotherapy, Topotecan
- Abstract
Purpose: We report the results of the French multicentric phase II study MIITOP (NCT00960739), which evaluated tandem infusions of
131 I-metaiodobenzylguanidine (mIBG) and topotecan in children with relapsed/refractory metastatic neuroblastoma (NBL)., Methods: Patients received131 I-mIBG on day 1, with intravenous topotecan daily on days 1-5. A second activity of131 I-mIBG was given on day 21 to deliver a whole-body radiation dose of 4 Gy, combined with a second course of topotecan on days 21-25. Peripheral blood stem cells were infused on day 31., Results: Thirty patients were enrolled from November 2008 to June 2015. Median age at diagnosis was 5.5 years (2-20). Twenty-one had very high-risk NBL (VHR-NBL), that is, stage 4 NBL at diagnosis or at relapse, with insufficient response (i.e., less than a partial response of metastases and more than three mIBG spots) after induction chemotherapy; nine had progressive metastatic relapse. Median Curie score at inclusion was 6 (1-26). Median number of prior lines of treatment was 3 (1-7). Objective response rate was 13% (95% confidence interval [CI]: 4-31) for the whole population, 19% for VHR-NBL, and 0% for progressive relapses. Immediate tolerance was good, with nonhematologic toxicity limited to grade-2 nausea/vomiting in eight patients. Two-year event-free survival was 17% (95% CI: 6-32). Among the 16 patients with VHR-NBL who had not received prior myeloablative busulfan-melphalan consolidation, 13 had at least stable disease after MIITOP; 11 subsequently received busulfan-melphalan; four of them were alive (median follow-up: 7 years)., Conclusion: MIITOP showed acceptable tolerability in this heavily pretreated population and encouraging survival rates in VHR-NBL when followed by busulfan-melphalan., (© 2023 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)- Published
- 2023
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4. Neuroblastoma.
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Chung C, Boterberg T, Lucas J, Panoff J, Valteau-Couanet D, Hero B, Bagatell R, and Hill-Kayser CE
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- Child, Combined Modality Therapy, Humans, Neuroblastoma pathology, Prognosis, Neuroblastoma therapy
- Abstract
The survival of patients with high-risk neuroblastoma has improved significantly with the use of intensive multimodality treatment regimens, including chemotherapy, surgery, radiation therapy, myeloablative chemotherapy followed by stem cell rescue, and immunotherapy. This report summarizes the current treatment strategies used in the COG and SIOP for children with neuroblastoma. The improved global collaboration and the adoption of a uniform International Neuroblastoma Risk Group Staging System will help facilitate comparison of homogeneous pretreatment cohorts across clinical trials. Future research strategies regarding the indications for and dosages of radiation therapy to the primary and metastatic sites, and the integration of meta-iodobenzyl guanidine therapy into the multimodal treatment program, are discussed., (© 2021 Wiley Periodicals LLC.)
- Published
- 2021
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5. A nomogram of clinical and biologic factors to predict survival in children newly diagnosed with high-risk neuroblastoma: An International Neuroblastoma Risk Group project.
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Moreno L, Guo D, Irwin MS, Berthold F, Hogarty M, Kamijo T, Morgenstern D, Pasqualini C, Ash S, Potschger U, Ladenstein R, Valteau-Couanet D, Cohn SL, Pearson ADJ, and London WB
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- Age Factors, Bone Marrow Neoplasms drug therapy, Bone Marrow Neoplasms metabolism, Bone Marrow Neoplasms secondary, Child, Preschool, Female, Follow-Up Studies, Gene Amplification, Humans, Male, Neuroblastoma drug therapy, Neuroblastoma metabolism, Neuroblastoma pathology, Prognosis, Retrospective Studies, Survival Rate, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Biomarkers, Tumor analysis, Bone Marrow Neoplasms mortality, L-Lactate Dehydrogenase metabolism, N-Myc Proto-Oncogene Protein genetics, Neuroblastoma mortality, Nomograms
- Abstract
Background: Long-term outcome remains poor for children with high-risk neuroblastoma (five-year overall survival [OS] ∼50%). Our objectives were to (a) identify prognostic biomarkers and apply them in a nomogram to identify the subgroup of ultra-high-risk patients at highest risk of disease progression/death, for whom novel frontline therapy is urgently needed; and (b) validate the nomogram in an independent cohort., Methods: A total of 1820 high-risk patients (≥18 months old with metastatic neuroblastoma), diagnosed 1998-2015, from the International Neuroblastoma Risk Groups (INRG) Data Commons were analyzed in a retrospective cohort study. Using multivariable Cox regression of OS from diagnosis, a nomogram was created from prognostic biomarkers to predict three-year OS. External validation was performed using the SIOPEN HR-NBL1 trial cohort (n = 521), evidenced by receiver operating characteristic curves., Results: The nomogram, including MYCN status (P < 0.0001), lactate dehydrogenase (LDH) (P = 0.0007), and presence of bone marrow metastases (P = 0.004), had robust performance and was validated. Applying the nomogram at diagnosis (a) gives prognosis of an individual patient and (b) identifies patients predicted to have poor outcome (three-year OS was 30% ± 5% for patients with a nomogram score of > 82 points; 58% ± 1% for those ≤82 points). Median follow-up time was 5.5 years (range, 0-14.1)., Conclusions: In high-risk neuroblastoma, a novel, publicly available nomogram using prognostic biomarkers (MYCN status, LDH, presence of bone marrow metastases; https://neuroblastoma.shinyapps.io/High-Risk-Neuroblastoma-Nomogram/) has the flexibility to apply a clinically suitable and context-specific cutoff to identify patients at highest risk of death. This will facilitate testing urgently needed new frontline treatment options to improve outcome for these children., (© 2020 Wiley Periodicals LLC.)
- Published
- 2021
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6. Multidisciplinary surgical strategy for dumbbell neuroblastoma: A single-center experience of 32 cases.
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Pio L, Blanc T, de Saint Denis T, Irtan S, Valteau-Couanet D, Michon J, Brisse H, Galmiche-Rolland L, Joyeux L, Odent T, Harte C, Glorion C, Zerah M, and Sarnacki S
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- Adolescent, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Male, Neuroblastoma pathology, Prognosis, Prospective Studies, Retrospective Studies, Spinal Cord Neoplasms pathology, Neuroblastoma surgery, Neurosurgical Procedures methods, Spinal Cord Neoplasms surgery
- Abstract
Introduction: Prognosis of dumbbell neuroblastoma (NBL) is mainly determined by the sequelae induced by the tumor itself and the neurosurgical approach. However, after primary chemotherapy, surgical management of the residual tumor, especially the spinal canal component, remains controversial., Methods: We conducted a single-center retrospective cohort study over the last 15 years (2002-2017) including patients treated for NBL with spinal canal extension focusing on timing and type of surgery, complications, and functional and oncological follow-up., Results: Thirty-two children (14 M, 18 F) were managed for NBL, with the majority (26) presenting with NBL stroma poor while four had ganglioneuroblastoma intermixed, one nodular, and one ganglioneuroma. All but two patients received neoadjuvant chemotherapy. Upfront laminotomy for spinal cord decompression was performed in two patients; nine patients had extraspinal surgery with a follow-up neurosurgical procedure in seven cases; eight patients had initial neurosurgery followed by an extraspinal procedure, while six patients underwent a combined multidisciplinary approach. With a median follow up of 3.6 years (0.1-14.9), 29 patients (90.6) are alive and two out of three (19, 65.5%) have functional sequelae., Conclusion: Patients with NBL with persistent spinal canal extension of the tumor after neoadjuvant chemotherapy treated at our center had outcomes that compare favorably with the literature. This is likely due to the multidisciplinary approach to optimal surgical strategy and continuous evaluation of the respective risks of tumor progression. Neurological disability results from initial spinal cord compression or the radicular sacrifice required for tumor resection., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2019
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7. The challenge of defining "ultra-high-risk" neuroblastoma.
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Morgenstern DA, Bagatell R, Cohn SL, Hogarty MD, Maris JM, Moreno L, Park JR, Pearson AD, Schleiermacher G, Valteau-Couanet D, London WB, and Irwin MS
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- Disease-Free Survival, Humans, Neuroblastoma therapy, Risk Assessment, Risk Factors, Survival Rate, Neuroblastoma diagnosis, Neuroblastoma mortality
- Abstract
Given the biological and clinical heterogeneity of neuroblastoma, risk stratification is vital to determining appropriate treatment. Historically, most patients with high-risk neuroblastoma (HR-NBL) have been treated uniformly without further stratification. Attempts have been made to identify factors that can be used to risk stratify these patients and to characterize an "ultra-high-risk" (UHR) subpopulation with particularly poor outcome. However, among published data, there is a lack of consensus in the definition of the UHR population and heterogeneity in the endpoints and statistical methods used. This review summarizes our current understanding of stratification of HR-NBL and discusses the complex issues in defining UHR neuroblastoma., (© 2018 Wiley Periodicals, Inc.)
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- 2019
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8. Risk stratification of high-risk metastatic neuroblastoma: A report from the HR-NBL-1/SIOPEN study.
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Morgenstern DA, Pötschger U, Moreno L, Papadakis V, Owens C, Ash S, Pasqualini C, Luksch R, Garaventa A, Canete A, Elliot M, Wieczorek A, Laureys G, Kogner P, Malis J, Ruud E, Beck-Popovic M, Schleiermacher G, Valteau-Couanet D, and Ladenstein R
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- Age Factors, Child, Child, Preschool, Clinical Trials as Topic, Disease-Free Survival, Female, Ferritins blood, Humans, Infant, Kaplan-Meier Estimate, L-Lactate Dehydrogenase blood, Male, N-Myc Proto-Oncogene Protein genetics, Neuroblastoma mortality, Prognosis, Progression-Free Survival, Proportional Hazards Models, Risk Factors, Sex Factors, Biomarkers, Tumor analysis, Neuroblastoma pathology
- Abstract
Background: Risk stratification is crucial to treatment decision-making in neuroblastoma. This study aimed to explore factors present at diagnosis affecting outcome in patients aged ≥18 months with metastatic neuroblastoma and to develop a simple risk score for prognostication., Procedure: Data were derived from the European high-risk neuroblastoma 1 (HR-NBL1)/International Society for Paediatric Oncology European Neuroblastoma (SIOPEN) trial with analysis restricted to patients aged ≥18 months with metastatic disease and treated prior to the introduction of immunotherapy. Primary endpoint was 5-year event-free survival (EFS). Prognostic factors assessed were sex, age, tumour MYCN amplification (MNA) status, serum lactate dehydrogenase (LDH)/ferritin, primary tumour and metastatic sites. Factors significant in univariate analysis were incorporated into a multi-variable model and an additive scoring system developed based on estimated log-cumulative hazard ratios., Results: The cohort included 1053 patients with median follow-up 5.5 years and EFS 27 ± 1%. In univariate analyses, age; serum LDH and ferritin; involvement of bone marrow, bone, liver or lung; and >1 metastatic system/compartment were associated with worse EFS. Tumour MNA was not associated with worse EFS. A multi-variable model and risk score incorporating age (>5 years, 2 points), serum LDH (>1250 U/L, 1 point) and number of metastatic systems (>1, 2 points) were developed. EFS was significantly correlated with risk score: EFS 52 ± 9% for score = 0 versus 6 ± 3% for score = 5 (P < 0.0001)., Conclusions: A simple score can identify an "ultra-high risk" (UHR) cohort (score = 5) comprising 8% of patients with 5-year EFS <10%. These patients appear not to benefit from induction therapy and could potentially be directed earlier to alternative experimental therapies in future trials., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2018
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9. Event-free survival of infants and toddlers enrolled in the HR-NBL-1/SIOPEN trial is associated with the level of neuroblastoma mRNAs at diagnosis.
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Corrias MV, Parodi S, Tchirkov A, Lammens T, Vicha A, Pasqualini C, Träger C, Yáñez Y, Dallorso S, Varesio L, Luksch R, Laureys G, Valteau-Couanet D, Canete A, Pöetschger U, Ladenstein R, and Burchill SA
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- Area Under Curve, Female, Homeodomain Proteins biosynthesis, Humans, Infant, Infant, Newborn, Kaplan-Meier Estimate, Male, Neuroblastoma metabolism, Prognosis, Progression-Free Survival, Proportional Hazards Models, RNA, Messenger analysis, ROC Curve, Sensitivity and Specificity, Transcription Factors biosynthesis, Tyrosine 3-Monooxygenase biosynthesis, Biomarkers, Tumor analysis, Homeodomain Proteins analysis, Neuroblastoma mortality, Transcription Factors analysis, Tyrosine 3-Monooxygenase analysis
- Abstract
Background: The purpose of this study was to evaluate whether levels of neuroblastoma mRNAs in bone marrow and peripheral blood from stage M infants (≤12 months of age at diagnosis, MYCN amplified) and toddlers (between 12 and 18 months, any MYCN status) predict event-free survival (EFS)., Methods: Bone marrow aspirates and peripheral blood samples from 97 infants/toddlers enrolled in the European High-Risk Neuroblastoma trial were collected at diagnosis in PAXgene
™ blood RNA tubes. Samples were analyzed by reverse transcription quantitative polymerase chain reaction according to standardized procedures., Results: Bone marrow tyrosine hydroxylase (TH) or paired-like homeobox 2b (PHOX2B) levels in the highest tertile were associated with worse EFS; hazard ratios, adjusted for age and MYCN status, were 1.5 and 1.8 respectively. Expression of both TH and PHOX2B in the highest tertile predicted worse outcome (p = 0.015), and identified 20 (23%) infants/toddlers with 5-year EFS of 20% (95%CI: 4%-44%). Prognostic significance was maintained after adjusting for over-fitting bias (p = 0.038), age and MYCN status. In peripheral blood, PHOX2B levels in the highest tertile predicted a two-fold increased risk of an event (p = 0.032), and identified 23 (34%) infants/toddlers with 5-year EFS of 29% (95%CI: 12%-48%). Time-dependent receiver operating characteristic analysis confirmed the prognostic value of combined TH and PHOX2B in bone marrow and of PHOX2B in peripheral blood during the first year of follow-up., Conclusions: High levels of bone marrow TH and PHOX2B and of peripheral blood PHOX2B at diagnosis allow early identification of a group of high-risk infant and toddlers with neuroblastoma who may be candidates for alternative treatments. Integration with additional biomarkers, as well as validation in additional international trials is warranted., (© 2018 Wiley Periodicals, Inc.)- Published
- 2018
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10. Efficacy of nivolumab in a patient with systemic refractory ALK+ anaplastic large cell lymphoma.
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Rigaud C, Abbou S, Minard-Colin V, Geoerger B, Scoazec JY, Vassal G, Jaff N, Heuberger L, Valteau-Couanet D, and Brugieres L
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- Adolescent, Anaplastic Lymphoma Kinase antagonists & inhibitors, Humans, Male, Neoplasm Proteins antagonists & inhibitors, Anaplastic Lymphoma Kinase metabolism, Lymphoma, Large-Cell, Anaplastic diagnosis, Lymphoma, Large-Cell, Anaplastic drug therapy, Lymphoma, Large-Cell, Anaplastic enzymology, Lymphoma, Large-Cell, Anaplastic pathology, Neoplasm Proteins metabolism, Nivolumab administration & dosage
- Published
- 2018
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11. Image-defined risk factors in unresectable neuroblastoma: SIOPEN study on incidence, chemotherapy-induced variation, and impact on surgical outcomes.
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Avanzini S, Pio L, Erminio G, Granata C, Holmes K, Gambart M, Buffa P, Castel V, Valteau Couanet D, Garaventa A, Pistorio A, Cecchetto G, Martucciello G, Mattioli G, and Sarnacki S
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- Adolescent, Child, Child, Preschool, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Infant, Male, Neoplasm Staging, Neoplasm, Residual diagnostic imaging, Neoplasm, Residual drug therapy, Neoplasm, Residual surgery, Neuroblastoma diagnostic imaging, Neuroblastoma drug therapy, Neuroblastoma surgery, Prognosis, Risk Assessment, Survival Rate, Tomography, X-Ray Computed, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Induction Chemotherapy, Neoplasm, Residual pathology, Neuroblastoma pathology
- Abstract
Purpose: To evaluate the impact of image-defined risk factor (IDRF) modification after chemotherapy on surgical outcomes, event-free survival (EFS), and overall survival (OS) among patients enrolled in the European Unresectable Neuroblastoma (EUNB) study., Methods: IDRFs were assigned according to the corresponding surgical risk factors list reported in the database. Surgical outcomes, EFS, and OS were related to IDRF modification with chemotherapy. The predictive value of preoperative IDRF for surgical outcomes was analyzed. Cox proportional hazards models for EFS and OS, including preoperative IDRF, surgical outcomes, and other known clinical risk factors, were created., Results: Of the 160 patients enrolled in the EUNB study, 143 patients met the inclusion criteria. A total of 228 IDRF were thus collected. Following chemotherapy, 76 (33%) IDRF disappeared in 32.2% of patients, 33 (14%) new IDRF appeared in 18.8% of patients, and 49% of patients did not show any IDRF change. Complete resection/minimal residual disease (71.2%) was more frequent among children who had disappearance/numerical reduction of IDRF (P = 0.005). Infiltration of the branches of the mesenteric artery was predictive of an unfavorable surgical outcome. Prolonged preoperative chemotherapy over five courses and encasement of the celiac axis and/or mesenteric artery origin impacted EFS and OS., Conclusions: The unchanged IDRF pattern in 50% of patients and the appearance of new IDRF during chemotherapy in approximately 20% of patients strengthens the idea that prolonged chemotherapy is useless for improving surgical resection in this population of patients. In addition, midline perivascular abdominal preoperative IDRF appeared to be predictive not only of surgical outcomes but also of EFS and OS., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2017
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12. Outcome of children with relapsed or refractory neuroblastoma: A meta-analysis of ITCC/SIOPEN European phase II clinical trials.
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Moreno L, Rubie H, Varo A, Le Deley MC, Amoroso L, Chevance A, Garaventa A, Gambart M, Bautista F, Valteau-Couanet D, Geoerger B, Vassal G, Paoletti X, and Pearson AD
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- Adolescent, Child, Child, Preschool, Dacarbazine administration & dosage, Dacarbazine analogs & derivatives, Doxorubicin administration & dosage, Europe, Female, Humans, Infant, Male, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Neuroblastoma pathology, Prognosis, Survival Rate, Temozolomide, Topotecan administration & dosage, Vincristine administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Clinical Trials, Phase II as Topic, Drug Resistance, Neoplasm drug effects, Neoplasm Recurrence, Local drug therapy, Neuroblastoma drug therapy, Salvage Therapy
- Abstract
Background: Few randomized trials have been conducted in children with relapsed/refractory neuroblastoma and data about outcomes including progression-free survival (PFS) in these patients are scarce., Procedure: A meta-analysis of three phase II studies of children with relapsed/refractory neuroblastoma conducted in Europe (temozolomide, topotecan-vincristine-doxorubicin and topotecan-temozolomide) was performed. Individual patient data with extended follow-up were collected from the trial databases after publication to describe trial outcomes (response rate, clinical benefit ratio, duration of treatment, PFS, and overall survival [OS]). Characteristics of subjects with relapsed/refractory neuroblastoma were compared., Results: Data from 71 children and adolescents with relapsed/refractory neuroblastoma were collected. Response definitions were not homogeneous in the three trials. Patients were on study for a median of 3.5 months (interquartile range [IQR] 1.9-6.2). Of those, 35.2% achieved a complete or partial response, 26.3% experienced a response after more than two cycles, and 23.9% received more than six cycles. Median PFS from study entry for all, refractory, and relapsed patients was 6.4 ± 1.0, 12.5 ± 6.8, and 5.7 ± 1.0 months, respectively (P = 0.006). Median OS from study entry for all, refractory, and relapsed patients was 16.1 ± 4.3, 27.9 ± 20.2, and 11.0 ± 1.6 months, respectively (P = 0.03)., Conclusions: Baseline data for response rate, clinical benefit ratio, duration of treatment, PFS, and OS were provided. Two subpopulations (relapsed/refractory) were clearly distinct and should be included in the interpretation of all trials. These results should help informing the design of forthcoming studies in relapsed/refractory neuroblastoma., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2017
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13. Image-defined risk factor assessment of neurogenic tumors after neoadjuvant chemotherapy is useful for predicting intra-operative risk factors and the completeness of resection.
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Irtan S, Brisse HJ, Minard-Colin V, Schleiermacher G, Galmiche-Rolland L, Le Cossec C, Elie C, Canale S, Michon J, Valteau-Couanet D, and Sarnacki S
- Subjects
- Abdominal Neoplasms diagnostic imaging, Abdominal Neoplasms drug therapy, Abdominal Neoplasms epidemiology, Abdominal Neoplasms pathology, Abdominal Neoplasms surgery, Adolescent, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Carboplatin administration & dosage, Child, Child, Preschool, Combined Modality Therapy, Cyclophosphamide administration & dosage, Etoposide administration & dosage, Female, Ganglioneuroblastoma diagnostic imaging, Ganglioneuroblastoma drug therapy, Ganglioneuroblastoma epidemiology, Ganglioneuroblastoma pathology, Ganglioneuroblastoma surgery, Hematopoietic Stem Cell Transplantation, Humans, Infant, Kaplan-Meier Estimate, Male, Neoplasm Staging, Neoplasm, Residual, Neuroblastoma diagnostic imaging, Neuroblastoma drug therapy, Neuroblastoma pathology, Neuroblastoma surgery, Postoperative Complications epidemiology, Postoperative Complications prevention & control, Risk Assessment, Risk Factors, Thoracic Neoplasms diagnostic imaging, Thoracic Neoplasms drug therapy, Thoracic Neoplasms epidemiology, Thoracic Neoplasms pathology, Thoracic Neoplasms surgery, Treatment Outcome, Vincristine administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Diagnostic Imaging methods, Magnetic Resonance Imaging, Neoadjuvant Therapy, Neuroblastoma epidemiology, Tomography, X-Ray Computed
- Abstract
Background: Patients with neuroblastoma are now stratified at diagnosis according to the presence and number of image-defined risk factors (IDRFs). We examined the added value of IDRF assessment after neoadjuvant chemotherapy for predicting surgical resection., Material and Methods: From 2009-2012, 39 out of 91 patients operated on in our institution for neuroblastic tumors received neoadjuvant chemotherapy based on ongoing SIOPEN protocols or treatment guidelines. IDRFs were assessed both at diagnosis and preoperatively on CT and/or MRI., Results: Median age at diagnosis was 30 months [range 2-191]. The tumor locations were adrenal (n = 20), paravertebral (n = 13) and perivascular (n = 6). INRGSS stages were L2 (n = 13), M (n = 25) and Ms (n = 1). Eleven tumors (28%) were MYCN-amplified. Chemotherapy reduced the number of IDRFs in 54% of patients overall (21/39): 61.5% (16/26) of M and Ms patients, and 38.5% (5/13) of non metastatic patients (P < 0.001). The number of IDRFs lost after chemotherapy was proportional to the degree of tumor shrinkage (P = 0.002), independent of the primary tumor location (P = 0.73), although the number was higher in patients with left versus right adrenal locations (P = 0.004). Patients with neuroblastoma on post-surgical histology lost more IDRFs (median: 1[0-9]) than patients with ganglioneuroblastoma (median: 0[0-4]) (P < 0.001). The completeness of resection was related only to the number of preoperative IDRFs (P = 0.028)., Conclusion: IDRF assessment after neoadjuvant chemotherapy is useful for predicting completeness of resection of neurogenic tumors. A larger international study is needed to confirm these results and to explore a possible correlation between preoperative IDRF status and survival., (© 2015 Wiley Periodicals, Inc.)
- Published
- 2015
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14. In memoriam--Jean Lemerle (1930-2014).
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Oberlin O, Harif M, Perilongo G, Valteau-Couanet D, d'Angio GJ, and Patte C
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- History, 20th Century, History, 21st Century, Humans, Medical Oncology history, Pediatrics history
- Published
- 2014
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15. Tandem high-dose chemotherapy and autologous stem cell rescue in children with newly diagnosed high-risk medulloblastoma or supratentorial primitive neuro-ectodermic tumors.
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Dufour C, Kieffer V, Varlet P, Raquin MA, Dhermain F, Puget S, Valteau-Couanet D, and Grill J
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- Adolescent, Adult, Autografts, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Male, Retrospective Studies, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Medulloblastoma diagnosis, Medulloblastoma therapy, Neuroectodermal Tumors, Primitive diagnosis, Neuroectodermal Tumors, Primitive therapy, Stem Cell Transplantation
- Abstract
Background: To assess the feasibility and effectiveness of high-dose chemotherapy (HDC) with stem cell support followed by conventional craniospinal radiotherapy (RT) as treatment for children older than 5 years of age with newly diagnosed high-risk medulloblastoma (MB) or supratentorial PNET (sPNET)., Procedure: Between May 2001 and April 2010, 24 children older than 5 years of age (MB = 21; sPNET = 3), fulfilling inclusion criteria at diagnosis, were treated at Gustave Roussy. After conventional chemotherapy, they received two courses of high-dose thiotepa (600 mg/m(2)) followed by craniospinal RT., Results: The median follow-up was 4.4 years (range, 0.8-11.3 years). For children with metastatic MB, the 5-year event-free survival (EFS) and overall survival (OS) were 72% and 83%, respectively. The toxicity was manageable. No toxic death occurred. At the most recent evaluation, among the 24 children who had at least one Full Scale Intellectual Quotient (FSIQ) examination at a median follow-up of 3.79 years after diagnosis, the mean estimated FSIQ was 82 (range, 56-114)., Conclusions: In children with metastatic MB, tandem HDCT with ASCT followed by conventional craniospinal RT proved its feasibility without jeopardizing survival., (© 2014 Wiley Periodicals, Inc.)
- Published
- 2014
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16. Vemurafenib in pediatric patients with BRAFV600E mutated high-grade gliomas.
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Bautista F, Paci A, Minard-Colin V, Dufour C, Grill J, Lacroix L, Varlet P, Valteau-Couanet D, and Geoerger B
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- Antibodies, Monoclonal, Humanized administration & dosage, Antineoplastic Agents adverse effects, Antineoplastic Agents pharmacokinetics, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Astrocytoma enzymology, Bevacizumab, Brain Neoplasms enzymology, Camptothecin administration & dosage, Camptothecin analogs & derivatives, Cancer Vaccines therapeutic use, Child, Combined Modality Therapy, Cranial Irradiation, Dacarbazine administration & dosage, Dacarbazine analogs & derivatives, Doxorubicin administration & dosage, Doxorubicin analogs & derivatives, Drug Evaluation, Fatal Outcome, Ganglioglioma enzymology, Ganglioglioma radiotherapy, Ganglioglioma surgery, Humans, Immunotherapy, Indoles adverse effects, Indoles pharmacokinetics, Infant, Irinotecan, Male, Neoplasm Proteins genetics, Neoplasm Proteins physiology, Polyethylene Glycols administration & dosage, Protein Kinase Inhibitors adverse effects, Protein Kinase Inhibitors pharmacokinetics, Proto-Oncogene Proteins B-raf genetics, Proto-Oncogene Proteins B-raf physiology, Salvage Therapy, Sulfonamides adverse effects, Sulfonamides pharmacokinetics, Temozolomide, Thalamus, Treatment Outcome, Vemurafenib, Antineoplastic Agents therapeutic use, Astrocytoma drug therapy, Brain Neoplasms drug therapy, Ganglioglioma drug therapy, Indoles therapeutic use, Mutation, Missense, Neoplasm Proteins antagonists & inhibitors, Point Mutation, Protein Kinase Inhibitors therapeutic use, Proto-Oncogene Proteins B-raf antagonists & inhibitors, Sulfonamides therapeutic use
- Abstract
We present three pediatric patients with BRAFV600E mutant high-grade gliomas treated by vemurafenib on a nominative authorization level at our institution. One patient with anaplastic ganglioglioma experienced confirmed partial tumor response and significant clinical improvement and she is alive 20 months after start of treatment. A second patient with ganglioglioma responded transiently to re-introduction of vemurafenib after immunotherapy. Pharmacokinetic studies suggest that maximum concentration and exposure of vemurafenib at steady-state is dose-dependent and similar in children to that reported in adults. These cases suggest that BRAFV600 is an oncogenic driver in pediatric gliomas. Further exploration in clinical studies is ongoing., (© 2013 Wiley Periodicals, Inc.)
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- 2014
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17. Long-term results of the combination of the N7 induction chemotherapy and the busulfan-melphalan high dose chemotherapy.
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Valteau-Couanet D, Le Deley MC, Bergeron C, Ducassou S, Michon J, Rubie H, Le Teuff G, Coze C, Plantaz D, Sirvent N, Bouzy J, Chastagner P, and Hartmann O
- Subjects
- Abdominal Neoplasms drug therapy, Abdominal Neoplasms surgery, Antineoplastic Combined Chemotherapy Protocols adverse effects, Busulfan administration & dosage, Child, Child, Preschool, Combined Modality Therapy, Consolidation Chemotherapy, Disease-Free Survival, Follow-Up Studies, Gene Amplification, Genes, myc, Hematopoietic Stem Cell Transplantation, Hepatic Veno-Occlusive Disease chemically induced, Humans, Infant, Kaplan-Meier Estimate, Melphalan administration & dosage, Myeloablative Agonists therapeutic use, Neuroblastoma secondary, Neuroblastoma surgery, Proportional Hazards Models, Remission Induction, Thoracic Neoplasms drug therapy, Thoracic Neoplasms surgery, Transplantation Conditioning, Transplantation, Autologous, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Neuroblastoma drug therapy
- Abstract
Background: To evaluate long-term survival of the first cohort of stage-4 neuroblastoma patients treated with the N7 induction chemotherapy, surgery of the primary tumor and high-dose chemotherapy (HDC) containing Busulfan-Melphalan (Bu-Mel) followed by autologous stem cell transplantation (ASCT)., Procedure: From 1998 to 1999, 47 children were included in the NB97 trial and treated with induction chemotherapy according to the N7 protocol, followed by surgery of the primary tumor. HDC (Busulfan, 600 mg/m(2) Melphalan, 140 mg/m(2) ) was administered in patients with partial response of metastases with no more than 3 mIBG spots. Radiotherapy was delivered to the primary tumor site when tumors displayed MYCN amplification., Results: Thirty-nine patients received Bu-Mel (83%): 23 who had achieved complete response (CR) of metastases, 20 after induction treatment and 3 after second-line chemotherapy, and 16 in partial response (PR). The toxicity of the whole treatment was manageable. The main HDC related-toxicity was hepatic veno-occlusive disease grade > 2 occurring in 15% of the patients. The 8-year EFS of the whole cohort was 34% (95% CI, 22-48%). The 8-year EFS of the 39 patients who received Bu-Mel and ASCT was 41% (95% CI, 27-57%). Patients who achieved a CR of metastases at the end of induction chemotherapy had a significantly better outcome than the others (8-year EFS, 52% vs. 20%; P = 0.02)., Conclusions: The long-term results of this first prospective cohort of patients with metastatic disease treated with the N7 induction chemotherapy and HDC (Bu-Mel) confirm published data with stable survival curves but with a longer follow-up., (© 2013 Wiley Periodicals, Inc.)
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- 2014
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18. High-dose busulfan-thiotepa with autologous stem cell transplantation followed by posterior fossa irradiation in young children with classical or incompletely resected medulloblastoma.
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Bergthold G, El Kababri M, Varlet P, Dhermain F, Sainte-Rose C, Raquin MA, Kieffer V, Goma G, Grill J, Valteau-Couanet D, and Dufour C
- Subjects
- Busulfan administration & dosage, Cerebellar Neoplasms surgery, Child, Preschool, Combined Modality Therapy, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Infant, Infratentorial Neoplasms surgery, Male, Medulloblastoma surgery, Neuropsychological Tests, Prognosis, Retrospective Studies, Thiotepa administration & dosage, Transplantation, Autologous, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cerebellar Neoplasms therapy, Cranial Irradiation, Infratentorial Neoplasms therapy, Medulloblastoma therapy, Stem Cell Transplantation
- Abstract
Background: The aim of the study is to evaluate the outcome of young children with high risk localized medulloblastomas (newly diagnosed classical or incompletely resected) treated by high-dose busulfan-thiotepa with autologous stem cell rescue (ASCT) followed by focal radiation therapy (RT)., Procedure: Between September 1994 and January 2010, 19 children younger than 5 years old at diagnosis fulfilling the above inclusion criteria were treated at the Institute Gustave Roussy. After conventional chemotherapy, they received busulfan at a dose of 600 mg/m(2) and thiotepa at a dose of 900 mg/m(2) followed by ASCT. Focal RT was delivered at least 70 days after ASCT., Results: The median follow-up was 40.5 months (range, 14.5-191.2 months). The 3-year event-free survival (EFS) and OS were 68% (95% CI 45-84%) and 84% (95% CI 61-94%), respectively. Acute toxicity consisted mainly in hepatic veno-occlusive disease (6/19 patients) and bone marrow aplasia (all patients). No toxic death occurred. The Full Scale Intellectual Quotient tended to decrease over time at a mean rate of 0.9 point per year from the date of diagnosis., Conclusions: This intensive treatment resulted in a high overall survival rate in young children with newly diagnosed non-metastatic classic or incompletely resected MB. In spite of a high incidence of hepatic veno-occlusive disease (32%), the acute toxicity was manageable. Delayed neuropsychological side effects remain main concerns. These results should to be confirmed in a larger cohort., (© 2014 Wiley Periodicals, Inc.)
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- 2014
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19. Impact of extensive surgery in multidisciplinary approach of pterygopalatine/infratemporal fossa soft tissue sarcoma.
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Minard-Colin V, Kolb F, Saint-Rose C, Fayard F, Janot F, Rey A, Canale S, Julieron M, Corradini N, Raquin MA, Habrand JL, Grill J, George B, Ba Huy PT, Couloignier V, Terrier-Lacombe MJ, Luboinski B, Valteau-Couanet D, and Oberlin O
- Subjects
- Adolescent, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Child, Combined Modality Therapy, Disease Progression, Female, Head and Neck Neoplasms drug therapy, Head and Neck Neoplasms radiotherapy, Head and Neck Neoplasms surgery, History, Medieval, Humans, Infant, Kaplan-Meier Estimate, Male, Pterygopalatine Fossa pathology, Radiotherapy, Treatment Outcome, Young Adult, Sarcoma drug therapy, Sarcoma radiotherapy, Sarcoma surgery
- Abstract
Background: To evaluate a strategy whereby extensive surgery ± external radiotherapy (RT) could improve local control in pterygopalatine/infratemporal fossa (PIF) sarcoma., Procedure: Forty-one patients with a diagnosis of sarcoma involving the PIF and referred to our Institute from 1984 to 2009 were included in the analysis. Patients received multidrug chemotherapy and radiotherapy ± surgery, depending on the period of treatment., Results: The median age at diagnosis was 7.6 years (range: 0.1-22 years). There were 36 RMS, 3 undifferentiated sarcoma and 2 other soft-tissue sarcomas. Sixty-eight percent of patients had meningeal risk factors at diagnosis. Local treatment consisted of RT alone in 19 patients, surgery in combination to RT in 19 patients and surgery alone in 3 patients. The local progression rate (LPR) at 5 years was 45% for the entire population, 59% for the 19 patients treated with RT alone and 34% for the 22 patients who had surgery as part of their treatment. All locoregional failures after extensive surgery occurred at the skull base and/or in leptomeningeal spaces., Conclusions: Multidisciplinary approach including extensive surgery for PIF sarcoma is feasible and yields good local control with 15/22 patients in local complete remission. Future studies are warranted to confirm these promising results, to evaluate the possibility of avoiding RT or limiting the RT field, and to extend the indication for extensive surgery to other "worse" sites of PM sarcoma such as the paranasal sinuses., (Copyright © 2013 Wiley Periodicals, Inc.)
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- 2013
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20. Weight-based strategy of dose administration in children using intravenous busulfan: clinical and pharmacokinetic results.
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Michel G, Valteau-Couanet D, Gentet JC, Esperou H, Socié G, Méchinaud F, Doz F, Neven B, Bertrand Y, Galambrun C, Demeocq F, Yakouben K, Bordigoni P, Frappaz D, Nguyen L, and Vassal G
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- Adolescent, Antineoplastic Agents, Alkylating administration & dosage, Antineoplastic Agents, Alkylating pharmacokinetics, Area Under Curve, Child, Child, Preschool, Combined Modality Therapy, Female, Follow-Up Studies, Hepatic Veno-Occlusive Disease prevention & control, Humans, Infant, Injections, Intravenous, Male, Prognosis, Survival Rate, Tissue Distribution, Transplantation, Homologous, Body Weight, Busulfan administration & dosage, Busulfan pharmacokinetics, Hematologic Neoplasms therapy, Hematopoietic Stem Cell Transplantation
- Abstract
Background: A prospective clinical trial was performed in order to validate the pharmacokinetic (PK) and clinical benefits of a new dosing schedule of intravenous busulfan (IV Bu) in children., Procedure: IV Bu was administered as a 2-hr infusion every 6 hr for 4 days. Five dose levels were given according to body-weight strata., Results: The 67 children aged from 4 months to 17.2 years were followed up over 50 months after autologous or allogeneic stem-cell transplantation. Reduced PK variability was seen after IV Bu administration enabling efficient targeting with 78% of patients within the 900-1,500 µM · min therapeutic window and reproducible exposures across administrations. No neurological complications occurred. The low incidence of hepatic veno-occlusive disease (VOD) recorded was not correlated with high area under the curve (AUC). Only stomatitis was correlated with high AUC in the autologous group. The 4-year overall survival was 59% in the autologous group and 82% in the allogeneic group., Conclusion: The new dosing schedule using IV Bu provides adequate therapeutic targeting from the first administration, with low toxicity and good disease control in high-risk children. The choice of this formulation of Bu should be considered because of its low morbidity and good outcome., (Copyright © 2011 Wiley Periodicals, Inc.)
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- 2012
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21. A dose-intensive approach (NB96) for induction therapy utilizing sequential high-dose chemotherapy and stem cell rescue in high-risk neuroblastoma in children over 1 year of age.
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Monnereau-Laborde S, Munzer C, Valteau-Couanet D, Ansoborlo S, Coze C, Chastagner P, Rubie H, Demeocq F, Stephan JL, Hartmann O, and Perel Y
- Subjects
- Antineoplastic Combined Chemotherapy Protocols adverse effects, Child, Child, Preschool, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Infant, Male, Neuroblastoma diagnosis, Pilot Projects, Survival Analysis, Transplantation, Autologous, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Neuroblastoma therapy, Stem Cell Transplantation adverse effects
- Abstract
Background: To improve outcome and overall survival (OS) in high-risk neuroblastoma, NB96 induction therapy was intensified using sequential high-dose chemotherapy and autologous stem cell rescue., Procedure: Twenty children were included in this pilot study undertaken at seven reference centers in France, between May 1995 and October 1996. Induction began with one cycle of conventional chemotherapy followed by six sequential cycles of high-dose chemotherapy comprising two cycles of etoposide 800 mg/m(2)/day over 3 days, two cycles of cyclophosphamide 2,000 mg/m(2)/day over 3 days, and two cycles of carboplatin 400 mg/m(2)/day over 5 days, followed by stem cell rescue., Results: Thirteen patients (13/20) received this induction with acceptable toxicity and adequate stem cell harvest. Of these, nine (9/13) underwent surgery according to the protocol, while one patient was given a consolidation regimen prior to surgery. No toxic death was recorded. At the end of induction, complete remission was achieved in 10 cases (50%), with six still alive in July 2009. The 5-year event-free survival and OS were 35 ± 11% and 40 ± 11%, respectively., Conclusion: NB96 therapy is feasible and tolerated without lethal toxicity. Nevertheless, given the small sample size and absence of randomization in our study, the effectiveness of this strategy based on metastasis complete response rates and long-term outcome was not superior to other intensive chemotherapy regimens., (Copyright © 2011 Wiley-Liss, Inc.)
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- 2011
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22. Medulloblastoma in young children.
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Rutkowski S, Cohen B, Finlay J, Luksch R, Ridola V, Valteau-Couanet D, Hara J, Garre ML, and Grill J
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- Antineoplastic Agents therapeutic use, Child, Preschool, Combined Modality Therapy, Humans, Infant, Radiotherapy, Cerebellar Neoplasms therapy, Clinical Trials as Topic, Medulloblastoma therapy
- Abstract
In early childhood medulloblastoma, three distinct treatment strategies are currently used by different national groups to improve survival rates and to delay or avoid craniospinal radiotherapy: (1) systemic chemotherapy and high-dose chemotherapy, followed by radiotherapy at relapse; (2) systemic and intraventricular chemotherapy; (3) systemic chemotherapy and local conformal radiotherapy. A role for high-dose chemotherapy to delay or avoid craniospinal radiotherapy as a part of multimodal treatment strategies, especially in young children with metastatic or postoperative residual disease, has been recognized by different co-operative groups. Clinical and histological factors such as nodular-desmoplastic variants are considered as important prognostic factors for risk-adapted treatment recommendations.
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- 2010
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23. Successful treatment for advanced small cell carcinoma of the ovary.
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Christin A, Lhomme C, Valteau-Couanet D, Dubrel M, and Hartmann O
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- Adolescent, Carcinoma, Small Cell pathology, Child, Combined Modality Therapy, Female, Humans, Ovarian Neoplasms pathology, Carcinoma, Small Cell therapy, Ovarian Neoplasms therapy
- Abstract
Small cell carcinoma of the ovary is a rare and aggressive malignant tumour with a poor prognosis. The authors describe two females, 12 and 13 years old, who presented with advanced stage disease. They were treated with surgical resection, multiagent chemotherapy and high-dose chemotherapy followed by autologous bone marrow transplantation. They remain free of disease more than 9.5 and 14 years since the diagnosis., ((c) 2007 Wiley-Liss, Inc.)
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- 2008
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24. Feasibility of ovarian tissue cryopreservation for prepubertal females with cancer.
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Poirot CJ, Martelli H, Genestie C, Golmard JL, Valteau-Couanet D, Helardot P, Pacquement H, Sauvat F, Tabone MD, Philippe-Chomette P, Esperou H, Baruchel A, and Brugieres L
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- Adolescent, Antineoplastic Combined Chemotherapy Protocols adverse effects, Child, Child, Preschool, Feasibility Studies, Female, Humans, Infant, Infertility, Female chemically induced, Infertility, Female therapy, Transplantation, Autologous, Cryopreservation methods, Neoplasms drug therapy, Organ Preservation, Ovary, Reproductive Techniques, Assisted
- Abstract
Background: Loss of fertility is one of the long-term adverse effects of high-dose chemotherapy or total body irradiation for cancer, even in children. Ovarian tissue cryopreservation (OTC) may make it possible for survivors of childhood cancer to have children. We evaluated the feasibility of this technique for prepubertal girls., Methods: Between September 2000 and February 2005, 49 prepubertal girls were referred to the Reproductive Biology Unit for OTC before sterilizing treatment., Results: One ovary each was collected from 47 patients, by laparoscopy in 24 patients and laporotomy in the others. In 16 cases, the ovary was harvested during laparotomy to resect a residual abdominal tumor. No complications occurred after operations. Ovarian tissue was frozen by a slow-cooling protocol, using DMSO and sucrose as cryoprotectants. An mean of 17.6 +/- 6.5 ovarian tissue fragments was cryopreserved per patient. Follicle concentration was evaluated histologically for 46 patients and a strong correlation was found between age and follicular density. None of the cases had visible ovarian tumor components. Ovarian cryopreservation was not carried out for two patients., Conclusion: The cryopreservation of ovarian tissue could be systematically offered even to prepubertal girls at risk of sterility due to gonadotoxic treatment.
- Published
- 2007
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25. Candida infections in children treated with conventional chemotherapy for solid tumors (transplant recipients excluded): The Institut Gustave Roussy Pediatrics Department experience.
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Ridola V, Chachaty E, Raimondo G, Corradini N, Brugieres L, Valteau-Couanet D, and Hartmann O
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- Adolescent, Amphotericin B therapeutic use, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Candidiasis diagnosis, Candidiasis drug therapy, Candidiasis mortality, Child, Child, Preschool, Female, Humans, Incidence, Infant, Male, Neoplasms drug therapy, Neoplasms mortality, Retrospective Studies, Risk Factors, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols adverse effects, Candidiasis etiology, Neoplasms complications
- Abstract
Introduction: Advances in medical therapy have greatly improved the survival of children suffering from cancer. Although progress has been made in the eradication of malignant disease there is growing concern for the development of fungal infections in patients treated with chemotherapy., Materials and Methods: We reviewed all episodes of pediatric candidemia that occurred between January 1988 and December 2000. We analyzed the general characteristics of this population, risk factors, microbiology features, treatment, complications, and outcome., Results: Seventeen cases of candidemia were observed during the 12 years of the study at an estimated incidence of 0.4%. Neutropenia occurred at the onset of infection in 13/17 (76.5%) children. A central venous device was present in all cases. Seventy-seven percent of the infections were caused by Candida albicans and in 85% of patients, yeasts had colonized the gastrointestinal tract. In 9/17 patients visceral dissemination was documented. Overall, in 77% of the episodes the outcome was favorable., Conclusions: Candidemia is a rare but severe complication in pediatric oncology. Even if the prognosis is better in children than in adults, Candida septicemia remains of great concern since a high percentage of these infections result in visceral dissemination and mortality is still elevated., (Copyright 2003 Wiley-Liss, Inc.)
- Published
- 2004
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