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  1. Article ; Online: Identifying brain tumours in children and young adults.

    Wilne, S H / Dineen, R A / Dommett, R M / Chu, T P C / Walker, D A

    BMJ (Clinical research ed.)

    2013  Volume 347, Page(s) f5844

    MeSH term(s) Adolescent ; Brain Neoplasms/diagnosis ; Brain Neoplasms/therapy ; Child ; Early Diagnosis ; Humans ; Risk Factors ; Young Adult
    Language English
    Publishing date 2013-10-09
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.f5844
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: The presenting features of brain tumours: a review of 200 cases.

    Wilne, S H / Ferris, R C / Nathwani, A / Kennedy, C R

    Archives of disease in childhood

    2006  Volume 91, Issue 6, Page(s) 502–506

    Abstract: Objective: To determine the presenting features of brain tumours in children.: Design: Retrospective case note review.: Setting: Paediatric and neurosurgical services at the Wessex Neurology Centre and Southampton General Hospital, UK.: Patients! ...

    Abstract Objective: To determine the presenting features of brain tumours in children.
    Design: Retrospective case note review.
    Setting: Paediatric and neurosurgical services at the Wessex Neurology Centre and Southampton General Hospital, UK.
    Patients: 200 patients presenting with a CNS tumour between 1988 and 2001.
    Results: The commonest first presenting symptoms were headache (41%), vomiting (12%), unsteadiness (11%), visual difficulties (10%), educational or behavioural problems (10%), and seizures (9%). The commonest symptoms occurring at any time were headache (56%), vomiting (51%), educational or behavioural problems (44%), unsteadiness (40%), and visual difficulties (38%). Neurological signs were present at diagnosis in 88%: 38% had papilloedema, 49% cranial nerve abnormalities, 48% cerebellar signs, 27% long tract signs, 11% somatosensory abnormalities, and 12% a reduced level of consciousness. The median symptom interval was 2.5 months (range 1 day to 120 months). A short symptom interval was significantly associated with high grade tumours and patient age of 3 years or younger.
    Conclusions: The well known predominance of headache in children with CNS tumours is confirmed. Visual, behavioural, and educational symptoms were also prominent. With the exception of seizures, every initial symptom was accompanied by other symptoms or signs by the time of diagnosis. Questions about visual symptoms and educational or behavioural difficulties, as well as the more widely recognised symptoms of raised intracranial pressure and motor dysfunction, are important in the diagnosis of brain tumours, as are vision assessment and the appropriate plotting of growth and head size.
    MeSH term(s) Adolescent ; Brain Neoplasms/complications ; Brain Neoplasms/diagnosis ; Child ; Child Behavior Disorders/etiology ; Child, Preschool ; Female ; Headache/etiology ; Humans ; Infant ; Male ; Neuropsychological Tests ; Unconsciousness/etiology ; Vision Disorders/etiology ; Vomiting/etiology
    Language English
    Publishing date 2006-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 524-1
    ISSN 1468-2044 ; 0003-9888 ; 1359-2998
    ISSN (online) 1468-2044
    ISSN 0003-9888 ; 1359-2998
    DOI 10.1136/adc.2005.090266
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Primary postoperative chemotherapy without radiotherapy for treatment of brain tumours other than ependymoma in children under 3 years: results of the first UKCCSG/SIOP CNS 9204 trial.

    Grundy, R G / Wilne, S H / Robinson, K J / Ironside, J W / Cox, T / Chong, W K / Michalski, A / Campbell, R H A / Bailey, C C / Thorp, N / Pizer, B / Punt, J / Walker, D A / Ellison, D W / Machin, D

    European journal of cancer (Oxford, England : 1990)

    2010  Volume 46, Issue 1, Page(s) 120–133

    Abstract: Background: Radiotherapy is an effective adjuvant treatment for brain tumours arising in very young children, but it has the potential to damage the child's developing nervous system at a crucial time - with a resultant reduction in IQ leading to ... ...

    Abstract Background: Radiotherapy is an effective adjuvant treatment for brain tumours arising in very young children, but it has the potential to damage the child's developing nervous system at a crucial time - with a resultant reduction in IQ leading to cognitive impairment, associated endocrinopathy and risk of second malignancy. We aimed to assess the role of a primary chemotherapy strategy in avoiding or delaying radiotherapy in children younger than 3 years with malignant brain tumours other than ependymoma, the results of which have already been published.
    Methods: Ninety-seven children were enrolled between March 1993 and July 2003 and, following diagnostic review, comprised: medulloblastoma (n=31), astrocytoma (26), choroid plexus carcinoma [CPC] (15), CNS PNET (11), atypical teratoid/rhabdoid tumours [AT/RT] (6) and ineligible (6). Following maximal surgical resection, chemotherapy was delivered every 14 d for 1 year or until disease progression. Radiotherapy was withheld in the absence of progression.
    Findings: Over all diagnostic groups the cumulative progression rate was 80.9% at 5 years while the corresponding need-for-radiotherapy rate for progression was 54.6%, but both rates varied by tumour type. There was no clear relationship between chemotherapy dose intensity and outcome. Patients with medulloblastoma presented as a high-risk group, 83.9% having residual disease and/or metastases at diagnosis. For these patients, outcome was related to histology. The 5-year OS for desmoplastic/nodular medulloblastoma was 52.9% (95% confidence interval (CI): 27.6-73.0) and for classic medulloblastoma 33.3% (CI: 4.6-67.6); the 5-year EFS were 35.3% (CI: 14.5-57.0) and 33.3% (CI: 4.6-67.6), respectively. All children with large cell or anaplastic variants of medulloblastoma died within 2 years of diagnosis. The 5-year EFS for non-brainstem high-grade gliomas [HGGs] was 13.0% (CI: 2.2-33.4) and the OS was 30.9% (CI: 11.5-52.8). For CPC the 5-year OS was 26.67% (CI: 8.3-49.6) without RT. This treatment strategy was less effective for AT/RT with 3-year OS of 16.7% (CI: 0.8-51.7) and CNS PNET with 1-year OS of 9.1% (CI: 0.5-33.3).
    Interpretation: The outcome for very young children with brain tumours is dictated by degree of surgical resection and histological tumour type and underlying biology as an indicator of treatment sensitivity. Overall, the median age at radiotherapy was 3 years and radiotherapy was avoided in 45% of patients. Desmoplastic/nodular sub-type of medulloblastoma has a better prognosis than classic histology, despite traditional adverse clinical features of metastatic disease and incomplete surgical resection. A subgroup with HGG and CPC are long-term survivors without RT. This study highlights the differing therapeutic challenges presented by the malignant brain tumours of early childhood, the importance of surgical approaches and the need to explore individualised brain sparing approaches to the range of malignant brain tumours that present in early childhood.
    MeSH term(s) Antineoplastic Combined Chemotherapy Protocols/administration & dosage ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Astrocytoma/drug therapy ; Astrocytoma/radiotherapy ; Astrocytoma/surgery ; Brain Neoplasms/drug therapy ; Brain Neoplasms/radiotherapy ; Brain Neoplasms/surgery ; Child, Preschool ; Choroid Plexus Neoplasms/drug therapy ; Choroid Plexus Neoplasms/radiotherapy ; Choroid Plexus Neoplasms/surgery ; Disease Progression ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Medulloblastoma/drug therapy ; Medulloblastoma/radiotherapy ; Medulloblastoma/surgery ; Neuroectodermal Tumors, Primitive/drug therapy ; Neuroectodermal Tumors, Primitive/radiotherapy ; Neuroectodermal Tumors, Primitive/surgery ; Radiotherapy, Adjuvant/methods ; Survival Analysis ; Teratoma/drug therapy ; Teratoma/radiotherapy ; Teratoma/surgery ; Treatment Outcome
    Language English
    Publishing date 2010-01
    Publishing country England
    Document type Clinical Trial ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 82061-1
    ISSN 1879-0852 ; 0277-5379 ; 0959-8049 ; 0964-1947
    ISSN (online) 1879-0852
    ISSN 0277-5379 ; 0959-8049 ; 0964-1947
    DOI 10.1016/j.ejca.2009.09.013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Primary postoperative chemotherapy without radiotherapy for intracranial ependymoma in children: the UKCCSG/SIOP prospective study.

    Grundy, Richard G / Wilne, Sophie A / Weston, Claire L / Robinson, Kath / Lashford, Linda S / Ironside, James / Cox, Tim / Chong, W Kling / Campbell, Richard H A / Bailey, Cliff C / Gattamaneni, Rao / Picton, Sue / Thorpe, Nicky / Mallucci, Conor / English, Martin W / Punt, Jonathan A G / Walker, David A / Ellison, David W / Machin, David

    The Lancet. Oncology

    2007  Volume 8, Issue 8, Page(s) 696–705

    Abstract: Background: Over half of childhood intracranial ependymomas occur in children younger than 5 years. As an adjuvant treatment, radiotherapy can be effective, but has the potential to damage the child's developing nervous system at a crucial time-with a ... ...

    Abstract Background: Over half of childhood intracranial ependymomas occur in children younger than 5 years. As an adjuvant treatment, radiotherapy can be effective, but has the potential to damage the child's developing nervous system at a crucial time-with a resultant reduction in IQ and cognitive impairment, endocrinopathy, and risk of second malignancy. We aimed to assess the role of a primary chemotherapy strategy in avoiding or delaying radiotherapy in children younger than 3 years with intracranial ependymoma.
    Methods: Between December, 1992, and April, 2003, we enrolled 89 children with ependymoma who were aged 3 years or younger at diagnosis, of whom nine had metastatic disease on pre-operative imaging. After maximal surgical resection, children received alternating blocks of myelosuppressive and non-myelosuppressive chemotherapy every 14 days for an intended duration of 1 year. Radiotherapy was withheld unless local imaging (ie, from the child's treatment centre) showed progressive disease.
    Findings: 50 of the 80 patients with non-metastatic disease progressed, 34 of whom were irradiated for progression. The 5-year cumulative incidence of freedom from radiotherapy for the 80 non-metastatic patients was 42% (95% CI 32-53). With a median follow-up of 6 years (range 1.5-11.3), overall survival for the non-metastatic patients at 3 years was 79.3% (95% CI 68.5-86.8) and at 5 years 63.4% (51.2-73.4). The corresponding values for event-free survival were 47.6% (36.2-58.1) and 41.8% (30.7-52.6). There was no significant difference in event-free or overall survival between complete and incomplete surgical resection, nor did survival differ according to histological grade, age at diagnosis, or site of disease. In 47 of 59 (80%) patients who progressed, relapse resulted from local control only. The median time to progression for the 59 patients who progressed was 1.6 years (range 0.1-10.2 years). The median age at irradiation of the whole group was 3.6 years (range 1.5-11.9). For the 80 non-metastatic patients, the 23 who achieved the highest relative dose intensity of chemotherapy had the highest post-chemotherapy 5-year overall survival of 76% (95% CI 46.6-91.2), compared with 52% (33.3-68.1) for the 32 patients who achieved the lowest relative dose intensity of chemotherapy.
    Interpretation: This protocol avoided or delayed radiotherapy in a substantial proportion of children younger than 3 years without compromising survival. These results suggest, therefore, that primary chemotherapy strategies have an important role in the treatment of very young children with intracranial ependymoma.
    MeSH term(s) Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Brain Neoplasms/drug therapy ; Brain Neoplasms/surgery ; Carboplatin/administration & dosage ; Chemotherapy, Adjuvant ; Child ; Child, Preschool ; Cisplatin/administration & dosage ; Cyclophosphamide/administration & dosage ; Ependymoma/drug therapy ; Ependymoma/surgery ; Female ; Humans ; Infant ; Male ; Methotrexate/administration & dosage ; Neoplasm Recurrence, Local/radiotherapy ; Prognosis ; Prospective Studies ; Treatment Outcome ; Vincristine/administration & dosage
    Chemical Substances Vincristine (5J49Q6B70F) ; Cyclophosphamide (8N3DW7272P) ; Carboplatin (BG3F62OND5) ; Cisplatin (Q20Q21Q62J) ; Methotrexate (YL5FZ2Y5U1)
    Language English
    Publishing date 2007-08
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2049730-1
    ISSN 1474-5488 ; 1470-2045
    ISSN (online) 1474-5488
    ISSN 1470-2045
    DOI 10.1016/S1470-2045(07)70208-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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