Adrenocortical tumours in children and adolescents: The EXPeRT/PARTNER diagnostic and therapeutic recommendations

Adrenocortical tumours (ACTs) are rare during childhood. A complete surgical resection provides the best chance of cure, but the role and efficacy of the adjuvant therapy are still controversial. Various histologic criteria of malignancy for ACTs adopted in children do not facilitate comparative studies and are not completely shared. Therefore, a sharp demarcation between benign and malignant lesions has not been recognised, making it difficult to identify who potentially needs perioperative therapy. This manuscript presents the internationally harmonised recommendations for the diagnosis and treatment of ACTs in children and adolescents, established by the European Cooperative Study Group for Paediatric Rare Tumours (EXPeRT) group within the EU-funded project PARTNER (Paediatric Rare Tumours Network - European Registry)

The 'Survivorship Passport' for childhood cancer survivors

Background: Currently, there are between 300,000 and 500,000 childhood cancer survivors (CCSs) in Europe. A significant proportion is at high risk, and at least 60% of them develop adverse health-related outcomes that can appear several years after treatment completion. Many survivors are unaware of their personal risk, and there seems to be a general lack of information among healthcare providers about pathophysiology and natural history of treatment-related complications. This can generate incorrect or delayed diagnosis and treatments. Method: The Survivorship Passport (SurPass) consists of electronic documents, which summarise the clinical history of the childhood or adolescent cancer survivor. It was developed by paediatric oncologists of the PanCare and SIOPE networks and IT experts of Cineca, together with parents, patients, and survivors' organisations within the European Union–funded European Network for Cancer research in Children and Adolescents. It consists of a template of a web-based, simply written document, translatable in all European languages, to be given to each CCS. The SurPass provides a summary of each survivor's clinical history, with detailed information about the original cancer and of treatments received, together with personalised follow-up and screening recommendations based on guidelines published by the International Guidelines Harmonization Group and PanCareSurFup. Results: The SurPass data schema contains a maximum of 168 variables and uses internationally approved nomenclature, except for radiotherapy fields, where a new classification was defined by radiotherapy experts. The survivor-specific screening recommendations are mainly based on treatment received and are automatically suggested, thanks to built-in algorithms. These may be adapted and further individualised by the treating physician in case of special disease and survivor circumstances. The SurPass was tested at the Istituto Giannina Gaslini, Italy, and received positive feedback. It is now being integrated at the institutional, regional and national level. Conclusions: The SurPass is potentially an essential tool for improved and more harmonised follow-up of CCS. It also has the potential to be a useful tool for empowering CCSs to be responsible for their own well-being and preventing adverse events whenever possible. With sufficient commitment on the European level, this solution should increase the capacity to respond more effectively to the needs of European CCS

Risk of subsequent primary oral cancer in a cohort of 69,460 5-year survivors of childhood and adolescent cancer in Europe: the PanCareSurFup study

Background Survivors of childhood cancer are at risk of subsequent primary malignant neoplasms (SPNs), but the risk for rarer types of SPNs, such as oral cancer, is uncertain. Previous studies included few oral SPNs, hence large-scale cohorts are required to identify groups at risks. Methods The PanCareSurFup cohort includes 69,460 5-year survivors of childhood cancer across Europe. Risks of oral SPNs were defined by standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence. Results One hundred and forty-five oral SPNs (64 salivary gland, 38 tongue, 20 pharynx, 2 lip, and 21 other) were ascertained among 143 survivors. Survivors were at 5-fold risk of an oral SPN (95% CI: 4.4-5.6). Survivors of leukaemia were at greatest risk (SIR = 19.2; 95% CI: 14.6-25.2) followed by bone sarcoma (SIR = 6.4, 95% CI: 3.7-11.0), Hodgkin lymphoma (SIR = 6.2, 95% CI: 3.9-9.9) and soft-tissue sarcoma (SIR = 5.0, 95% CI: 3.0-8.5). Survivors treated with radiotherapy were at 33-fold risk of salivary gland SPNs (95% CI: 25.3-44.5), particularly Hodgkin lymphoma (SIR = 66.2, 95% CI: 43.6-100.5) and leukaemia (SIR = 50.5, 95% CI: 36.1-70.7) survivors. Survivors treated with chemotherapy had a substantially increased risk of a tongue SPN (SIR = 15.9, 95% CI: 10.6-23.7). Conclusions Previous radiotherapy increases the risk of salivary gland SPNs considerably, while chemotherapy increases the risk of tongue SPNs substantially. Awareness of these risks among both health-care professionals and survivors could play a crucial role in detecting oral SPNs early.</p

Analyses pronostiques en oncologie pédiatrique : Identification de facteurs de susceptibilité tumorale ou individuelle à l’efficacité et/ou à la toxicité des traitements anticancéreux utilisés chez l’enfant

Therapeutic advances in pediatric oncology have improved survival rates reaching over 80%. In order to increase cure rates and decrease complications and treatment sequelae, international collaborative efforts led to the development of therapeutic trials stratified on major prognostic factors including biological factors. However, treatment adaptation to individual patient characteristics remains marginal.In this thesis, our objective was to better understand how somatic (tumor-related) and constitutional (patient-related) characteristics could modify efficacy and toxicity of anticancer therapies used in pediatric oncology. Several works were performed: 1- Prognostic analysis of tumor markers: assessment of the alpha-foetoprotéine (AFP) decline prognostic value in childhood malignant germ cell tumors; 2- Prognostic analysis of constitutional factors: (i) assessment of the interaction between gender and type of alkylating agents on efficacy and acute toxicity; (ii) assessment of the efficacy and toxicity impact of genetic polymorphisms in patients with osteosarcoma treated with high-dose methotrexate; 3- Risk factors analysis of long-term toxicities: analysis of severe ototoxicity in the French Childhood Cancer Survivors Study (FCCSS).Les progrès thérapeutiques en oncologie pédiatrique ont permis une amélioration des taux de survie qui dépassent aujourd’hui 80%. De façon à augmenter les taux de guérison et diminuer les complications et séquelles des traitements, des efforts collaboratifs internationaux ont permis le développement de protocoles thérapeutiques stratifiés sur les facteurs pronostiques majeurs incluant des facteurs biologiques tumoraux issus des analyses moléculaires et notamment génomiques. Cependant, si les traitements utilisés prennent de plus en plus en compte la biologie tumorale, leur adaptation aux facteurs individuels reste marginale. La thèse ici présentée cherche à mieux comprendre comment les caractéristiques tumorales et individuelles des patients modifient l’efficacité et la toxicité des thérapeutiques anticancéreuses utilisées en oncologie pédiatrique.Plusieurs travaux ont été réalisés :1- Etude de l’impact pronostique des facteurs tumoraux : évaluation de l’impact pronostique de la décroissance du marqueur tumoral alphafoetoprotéine (AFP) dans les tumeurs germinales malignes de l’enfant et de l’adolescent traitées par chimiothérapie ; 2- Etude de l’impact pronostique des facteurs constitutionnels : (i) évaluation de l’effet du sexe sur l’efficacité et la toxicité des agents alkylants ; (ii) évaluation de l’impact pronostique de polymorphismes génétiques de gènes impliqués dans le métabolisme du méthotrexate sur l’efficacité et/ou la toxicité du méthotrexate haute dose dans le traitement de l’ostéosarcome ;3- Etude des facteurs de risque de toxicité tardive : analyse de la de toxicité auditive sévère dans la cohorte des survivants à long terme de cancers pédiatriques (FCCSS)

Analyses pronostiques en oncologie pédiatrique : Identification de facteurs de susceptibilité tumorale ou individuelle à l’efficacité et/ou à la toxicité des traitements anticancéreux utilisés chez l’enfant

Therapeutic advances in pediatric oncology have improved survival rates reaching over 80%. In order to increase cure rates and decrease complications and treatment sequelae, international collaborative efforts led to the development of therapeutic trials stratified on major prognostic factors including biological factors. However, treatment adaptation to individual patient characteristics remains marginal.In this thesis, our objective was to better understand how somatic (tumor-related) and constitutional (patient-related) characteristics could modify efficacy and toxicity of anticancer therapies used in pediatric oncology. Several works were performed: 1- Prognostic analysis of tumor markers: assessment of the alpha-foetoprotéine (AFP) decline prognostic value in childhood malignant germ cell tumors; 2- Prognostic analysis of constitutional factors: (i) assessment of the interaction between gender and type of alkylating agents on efficacy and acute toxicity; (ii) assessment of the efficacy and toxicity impact of genetic polymorphisms in patients with osteosarcoma treated with high-dose methotrexate; 3- Risk factors analysis of long-term toxicities: analysis of severe ototoxicity in the French Childhood Cancer Survivors Study (FCCSS).Les progrès thérapeutiques en oncologie pédiatrique ont permis une amélioration des taux de survie qui dépassent aujourd’hui 80%. De façon à augmenter les taux de guérison et diminuer les complications et séquelles des traitements, des efforts collaboratifs internationaux ont permis le développement de protocoles thérapeutiques stratifiés sur les facteurs pronostiques majeurs incluant des facteurs biologiques tumoraux issus des analyses moléculaires et notamment génomiques. Cependant, si les traitements utilisés prennent de plus en plus en compte la biologie tumorale, leur adaptation aux facteurs individuels reste marginale. La thèse ici présentée cherche à mieux comprendre comment les caractéristiques tumorales et individuelles des patients modifient l’efficacité et la toxicité des thérapeutiques anticancéreuses utilisées en oncologie pédiatrique.Plusieurs travaux ont été réalisés :1- Etude de l’impact pronostique des facteurs tumoraux : évaluation de l’impact pronostique de la décroissance du marqueur tumoral alphafoetoprotéine (AFP) dans les tumeurs germinales malignes de l’enfant et de l’adolescent traitées par chimiothérapie ; 2- Etude de l’impact pronostique des facteurs constitutionnels : (i) évaluation de l’effet du sexe sur l’efficacité et la toxicité des agents alkylants ; (ii) évaluation de l’impact pronostique de polymorphismes génétiques de gènes impliqués dans le métabolisme du méthotrexate sur l’efficacité et/ou la toxicité du méthotrexate haute dose dans le traitement de l’ostéosarcome ;3- Etude des facteurs de risque de toxicité tardive : analyse de la de toxicité auditive sévère dans la cohorte des survivants à long terme de cancers pédiatriques (FCCSS)

Identification of Tumoral and Individual Susceptibility Factors to the Effectiveness and/or Toxicity of Childhood Cancer Treatments

Les progrès thérapeutiques en oncologie pédiatrique ont permis une amélioration des taux de survie qui dépassent aujourd’hui 80%. De façon à augmenter les taux de guérison et diminuer les complications et séquelles des traitements, des efforts collaboratifs internationaux ont permis le développement de protocoles thérapeutiques stratifiés sur les facteurs pronostiques majeurs incluant des facteurs biologiques tumoraux issus des analyses moléculaires et notamment génomiques. Cependant, si les traitements utilisés prennent de plus en plus en compte la biologie tumorale, leur adaptation aux facteurs individuels reste marginale. La thèse ici présentée cherche à mieux comprendre comment les caractéristiques tumorales et individuelles des patients modifient l’efficacité et la toxicité des thérapeutiques anticancéreuses utilisées en oncologie pédiatrique.Plusieurs travaux ont été réalisés :1- Etude de l’impact pronostique des facteurs tumoraux : évaluation de l’impact pronostique de la décroissance du marqueur tumoral alphafoetoprotéine (AFP) dans les tumeurs germinales malignes de l’enfant et de l’adolescent traitées par chimiothérapie ; 2- Etude de l’impact pronostique des facteurs constitutionnels : (i) évaluation de l’effet du sexe sur l’efficacité et la toxicité des agents alkylants ; (ii) évaluation de l’impact pronostique de polymorphismes génétiques de gènes impliqués dans le métabolisme du méthotrexate sur l’efficacité et/ou la toxicité du méthotrexate haute dose dans le traitement de l’ostéosarcome ;3- Etude des facteurs de risque de toxicité tardive : analyse de la de toxicité auditive sévère dans la cohorte des survivants à long terme de cancers pédiatriques (FCCSS).Therapeutic advances in pediatric oncology have improved survival rates reaching over 80%. In order to increase cure rates and decrease complications and treatment sequelae, international collaborative efforts led to the development of therapeutic trials stratified on major prognostic factors including biological factors. However, treatment adaptation to individual patient characteristics remains marginal.In this thesis, our objective was to better understand how somatic (tumor-related) and constitutional (patient-related) characteristics could modify efficacy and toxicity of anticancer therapies used in pediatric oncology. Several works were performed: 1- Prognostic analysis of tumor markers: assessment of the alpha-foetoprotéine (AFP) decline prognostic value in childhood malignant germ cell tumors; 2- Prognostic analysis of constitutional factors: (i) assessment of the interaction between gender and type of alkylating agents on efficacy and acute toxicity; (ii) assessment of the efficacy and toxicity impact of genetic polymorphisms in patients with osteosarcoma treated with high-dose methotrexate; 3- Risk factors analysis of long-term toxicities: analysis of severe ototoxicity in the French Childhood Cancer Survivors Study (FCCSS)

Analyses pronostiques en oncologie pédiatrique : Identification de facteurs de susceptibilité tumorale ou individuelle à l’efficacité et/ou à la toxicité des traitements anticancéreux utilisés chez l’enfant

Therapeutic advances in pediatric oncology have improved survival rates reaching over 80%. In order to increase cure rates and decrease complications and treatment sequelae, international collaborative efforts led to the development of therapeutic trials stratified on major prognostic factors including biological factors. However, treatment adaptation to individual patient characteristics remains marginal.In this thesis, our objective was to better understand how somatic (tumor-related) and constitutional (patient-related) characteristics could modify efficacy and toxicity of anticancer therapies used in pediatric oncology. Several works were performed: 1- Prognostic analysis of tumor markers: assessment of the alpha-foetoprotéine (AFP) decline prognostic value in childhood malignant germ cell tumors; 2- Prognostic analysis of constitutional factors: (i) assessment of the interaction between gender and type of alkylating agents on efficacy and acute toxicity; (ii) assessment of the efficacy and toxicity impact of genetic polymorphisms in patients with osteosarcoma treated with high-dose methotrexate; 3- Risk factors analysis of long-term toxicities: analysis of severe ototoxicity in the French Childhood Cancer Survivors Study (FCCSS).Les progrès thérapeutiques en oncologie pédiatrique ont permis une amélioration des taux de survie qui dépassent aujourd’hui 80%. De façon à augmenter les taux de guérison et diminuer les complications et séquelles des traitements, des efforts collaboratifs internationaux ont permis le développement de protocoles thérapeutiques stratifiés sur les facteurs pronostiques majeurs incluant des facteurs biologiques tumoraux issus des analyses moléculaires et notamment génomiques. Cependant, si les traitements utilisés prennent de plus en plus en compte la biologie tumorale, leur adaptation aux facteurs individuels reste marginale. La thèse ici présentée cherche à mieux comprendre comment les caractéristiques tumorales et individuelles des patients modifient l’efficacité et la toxicité des thérapeutiques anticancéreuses utilisées en oncologie pédiatrique.Plusieurs travaux ont été réalisés :1- Etude de l’impact pronostique des facteurs tumoraux : évaluation de l’impact pronostique de la décroissance du marqueur tumoral alphafoetoprotéine (AFP) dans les tumeurs germinales malignes de l’enfant et de l’adolescent traitées par chimiothérapie ; 2- Etude de l’impact pronostique des facteurs constitutionnels : (i) évaluation de l’effet du sexe sur l’efficacité et la toxicité des agents alkylants ; (ii) évaluation de l’impact pronostique de polymorphismes génétiques de gènes impliqués dans le métabolisme du méthotrexate sur l’efficacité et/ou la toxicité du méthotrexate haute dose dans le traitement de l’ostéosarcome ;3- Etude des facteurs de risque de toxicité tardive : analyse de la de toxicité auditive sévère dans la cohorte des survivants à long terme de cancers pédiatriques (FCCSS)

Post-treatment sperm cryopreservation practices in childhood and young adult cancer survivors

International audienceResearch question: What are current practices of post-treatment fertility preservation in male childhood cancer survivors (CCS) who have not benefitted from pre-therapeutic fertility preservation in France and other European countries?Design: A survey was conducted of all fertility preservation centres in France (n = 30) and European fertility specialists (n = 9) in five European countries. Eight clinical cases and 40 questions were included to assess the effect of age at diagnosis, type of treatment (alkylating-agents, orchidectomy, testicular radiotherapy) and sperm parameters on the probability of a post-treatment fertility preservation proposal. Demographic characteristics of the responding practitioner were also collected.Results: Post-treatment sperm cryopreservation was proposed by 100% of fertility specialists in cases of severe oligoasthenoteratozoospermia, 77-88% in cases of moderate oligoasthenoteratozoospermia and in 65-77% in cases of sperm motility and vitality impairment. In cases of normal sperm parameters, 27-54% of fertility specialists would propose post-treatment sperm cryopreservation. These results did not differ significantly according to the type of treatment received or to responder-related factors. Practices of European specialists were also guided by sperm parameter results; 44-67% of specialists responding that they would propose sperm cryopreservation in cases of moderate to severe sperm parameter alterations.Conclusion: Post-treatment semen analysis could be widely proposed to CCS who have not benefitted from pre-therapeutic fertility preservation. Post-treatment fertility preservation could be proposed in cases of persistent moderate to severe sperm parameter alterations. Guidelines would be important to homogenize practices and to encourage oncologists to refer CCS for fertility assessments

Excess healthcare expenditure in adults treated for solid cancer in childhood: a cohort study in France

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Sex-Cord Stromal Tumors in Children and Teenagers: Results of the TGM-95 Study

International audienceBACKGROUND:We present the results of the TGM-95 study for gonadal sex-cord stromal tumors (SCT).METHODS:Between 1995 and 2005, children (<18 years) with gonadal SCT were prospectively registered. Primary gonadal resection was recommended whenever feasible. Patients with disseminated disease or an incomplete resection received neoadjuvant or adjuvant VIP chemotherapy (etoposide, ifosfamide, cisplatinum).RESULTS:Thirty-eight children with ovarian SCT were registered. Median age was 10.7y. Endocrine symptoms were present in 21 cases. The histological diagnoses were as follows: juvenile (23) and adult (3) granulosa cell tumors, Sertoli-Leydig cell tumors (11), and mixed germ cell SCT (1). An initial oophorectomy ± salpingectomy led to complete resection in 23 patients who did not receive adjuvant treatment; two of them relapsed: one achieved second complete remission whereas the other one died of disease. Fifteen patients had tumor rupture and/or malignant ascites: 11 received chemotherapy and did not relapse, four did not receive chemotherapy and relapsed with a fatal outcome in two cases. With a median follow-up of 5.9y, the 5-y EFS and OS rates were respectively 85% and 94%. Eleven patients had localized testicular tumors (median age 0.83y): juvenile granulosa cell tumors (4), Sertoli or Leydig cell tumors (5) and not otherwise specified SCT (2). Treatment was surgery alone with an inguinal orchiectomy. None have relapsed (median follow-up: 5.4y).CONCLUSIONS:Childhood SCT carry favorable prognosis. In ovarian SCT, surgery should be complete and non-mutilating. Adjuvant chemotherapy efficiently prevents recurrences in cases of tumor rupture. In childhood testicular SCT, the prognosis is excellent with an inguinal orchiectomy, prompting the debate on testis-sparing surgery