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Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2018; 17: 92-102

Легочные метастазы при нейробластоме у детей

Шаманская Т.В. , Качанов Д.Ю. , Лихоткина В.И. , Терещенко Г.В. , Терновая Е.С. , Щербаков А.П. , Ликарь Ю.Н. , Рощин В.Ю. , Ольшанская Ю.В. , Казакова А.Н. , Варфоломеева С.Р.

https://doi.org/10.24287/1726-1708-2018-17-2-92-102

Аннотация

Поражение легких при метастатической форме нейробластомы (НБ) - крайне редкий случай. Такие пациенты имеют худший прогноз и более агрессивный характер течения основного заболевания. В статье представлен анализ эпидемиологических, клинических, визуализационных особенностей и прогноза заболевания в группе пациентов с 4-й стадией НБ и локализацией метастазов в легких, получавших лечение в НМИЦ ДГОИ им. Дмитрия Рогачева за период с 01.2012 по 12.2016 года (60 мес.). Пациенты, стратифицированные на группы риска, получали терапию по модифицированному протоколу NB-2004. Проведены сравнительный анализ пациентов высокой группы риска с метастазами в легкие и без них; оценка общей и бессобытийной выживаемости по методу Каплана-Мейера. Из 132 пациентов с 4-й стадией НБ в 10 (7,5%) случаях было выявлено метастатическое поражение легких (медиана возраста заболевших - 26,4 мес. (от 4,3 до 92,5 мес.). В группу высокого риска в рамках модифицированного протокола NB-2004 стратифицированы 9 (90%) пациентов; в группу промежуточного риска - 1 (10%). При сравнительном анализе пациентов с 4-й стадией НБ высокой группы риска с метастазами в легкие и без них не было отмечено статистической разницы при сравнении по полу, возрасту, локализации первичной опухоли, статусу гена MYCN, количеству сайтов метастатического поражения. Статистически чаще у пациентов с метастазами в легких отмечали прогрессию заболевания на фоне индукционной терапии (р = 0,02). Двухлетняя общая выживаемость в группе пациентов с метастазами в легких была ниже - 50,0 +- 15,8% против 75,9 +- 3,9% в группе пациентов без метастазов в легких (р = 0,045). В нашем исследовании наличие метастазов в легких встречалось чаще, чем описано в других работах, и является клинически важным, предвещая плохой прогноз.
Список литературы

1. Goodman M.T., Gurney J.G., Smith M.A., Olsham A.F. Sympathetic nervous system tumors. In: Ries L.AG., Smith M.A., Gurney J.G., et al, eds. ancer incidence and survival amoung children and adolescents: United States SEER Program 1975-1995. Bethesda, Md: National Cancer Institute 1999; 65-72.

2. Berthold F., Simon T. Clinical presentation. In: Neuroblastoma. Cheung N.K., Cohn S. eds. Springer-Verlag, Berlin, Heidelberg; 2005:63-86.

3. Brodeur G.M., Pritchard J., Berthold F., Carlsen N.L., Castel V., Castelberry R.P., et al. Revisions of the international criteria for neuroblastoma diagnosis, staging, and response to treatment. J Clin Oncol. 1993; 11(8): 1466-77.

4. Shimada H., Umehara S., Monobe Y., Hachitanda Y., Nakagawa A., Goto S., et al. International neuroblastoma pathology classification for prognostic evaluation of patients with peripheral neuroblastic tumors: a report from the Children's Cancer Group. Cancer 2001; 92 (9): 2451-61.

5. NB2004 protocol. Berthold F (principal investigator). http://www.kinderkrebsinfo.de/ dlja_specialistov/protokoly_gpoh/pohkinderkrebsinfotherapiestudien/nb2004/ index_rus.html [cited 2016 March 15].

6. DuBois S.G., Kalika Y., Lukens J.N., Brodeur G.M., et al. Metastatic sites in stage IV and IVS neuroblastoma correlate with age, tumor biology, and survival. J Pediatr Hematol Oncol 1999 May-Jun; 21 (3): 181-9.

7. Kammen B.F., Matthay K.K., Pacharn P., Gerbing R., et al. Pulmonary metastases at diagnosis of neuroblastoma in pediatric patients: CT findings and prognosis. AJR Am J Roentgenol. 2001 Mar;176(3):755-9.

8. Cowie F., Corbett R., Pinkerton C.R. Lung involvement in neuroblastoma: incidence and characteristics. Med Pediatr Oncol. 1997 Jun; 28(6): 429-32.

9. Brisse H.J., McCarville M.B., Grana-ta C., Krug K.B., Wootton-Gorges S.L., Kanegawa K., Giammarile F., et al. Guidelines for imaging and staging of neuroblastic tumors: consensus report from the International Neuroblastoma Risk Group Project International Neuroblastoma Risk Group Project. Radiology 2011; 261 (1): 243-57.

10. De la Monte S.M., Moore G.W., Hutchins G.M. Nonrandom distribution of metastases in neuroblastic tumors. Cancer 1983 Sep 1; 52 (5): 915-25.

11. Stigall R., Smith W.L., Franken E.A., Smith J.A., Crussi F.G. Intrapulmonic metastatic neuroblastoma. Ann Radiol (Paris). 1979 Mar-Apr; 22 (2-3): 223-7.

12. Towbin R., Gruppo R.A. Pulmonary metastases in neuroblastoma. AJR Am J Roentgenol 1982 Jan; 138 (1): 75-8.

13. Seo J.B., Im J.G., Goo J.M., Chung M.J., Kim M.Y. Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics 2001 Mar-Apr; 21 (2): 403-17.

14. Vik T.A., Pfluger T., Kadota R., Castel V., Tulchinsky M., Farto J.C., et al. (123)I-mIBG scintigraphy in patients with known or suspected neuroblastoma: Results from a prospective multicenter trial. Pediatr Blood Cancer 2009; 52: 784-90.

15. Sharp S.E., Gelfand M.J., Shulkin B.L. Pediatrics: diagnosis of neuroblastoma. Semin Nucl Med 2011; 41: 345-53.

16. Vallabhajosula S., Nikolopoulou A. Radioiodinated metaiodobenzylguanidine (MIBG): radiochemistry, biology, and pharmacology. Semin Nucl Med 2011; 41 (5): 324-33.

17. Yanik G.A., Parisi M.T., Shulkin B.L., et al. Semiquantitative mIBG scoring as a prognostic indicator in patients with stage 4 neuroblastoma: a report from the Children’s Oncology Group. J Nucl Med 2013; 54 (4): 541-8.

18. Nakajo M., Shapiro B., Copp J., et al. The normal and abnormal distribution of the adrenomedullary imaging agent m-[I-131] iodobenzylguanidine (I-131 MIBG) in man: evaluation by scintigraphy. J Nucl Med 1983; 24 (8): 672-82.

19. Parisi M.T., Sandler E.D., Hattner R.S. The biodistribution of metaiodobenzylguanidine. Semin Nucl Med 1992; 22 (1): 46-8.

20. Okuyama C., Sakane N., Yoshida T., et al. (123)I- or (125) I-metaiodobenzylgu-anidine visualization of brown adipose tissue. J Nucl Med 2002;43(9): 1234-40.

21. Okuyama C., Ushijima Y., Kubota T., et al. 123I-metaiodobenzylguanidine uptake in the nape of the neck of children: likely visualization of brown adipose tissue. J Nucl Med 2003; 44 (9): 1421-5.

22. Gelfand M.J. 123I-MIBG uptake in the neck and shoulders of a neuroblastoma patient: damage to sympathetic innerva-tion blocks uptake in brown adipose tissue. Pediatr Radiol 2004; 34 (7): 577-9.

23. Bonnin F., Lumbroso J., Tenenbaum F., Hartmann O., Parmentier C. Refining interpretation of MIBG scans in children. J Nucl Med 1994; 35 (5): 803-10.

24. Paltiel H.J., Gelfand M.J., Elgazzar A.H., et al. Neural crest tumors: I-123 MIBG imaging in children. Radiology 1994; 190(1): 117-21.

25. Acharya J., Chang P.T., Gerard P. Abnormal MIBG uptake in a neuroblastoma patient with right upper lobe atelectasis. Pediatr Radiol 2012; 42 (10): 1259-62.

26. Schindler T., Yu.C., Rossleigh M., Pereira J., Cohn R. False-positive MIBG uptake in pneumonia in a patient with stage IV neuroblastoma. Clin Nucl Med 2010; 35 (9): 743-5.

27. Kulatunge C.R., Son H. False-positive 123I-MIBG scintigraphy due to multiple focal nodular hyperplasia. Clin Nucl Med 2013; 38 (12): 976-8.

28. Yang J., Codreanu I., Servaes S., Zhu-ang H. Persistent intense MIBG activity in the liver caused by prior radiation. Clin Nucl Med 2014; 39 (10): 926-30.

29. Granata C., Carlini C., Conte M., Claudi-ani F., Campus R., Rizzo A. False positive MIBG scan due to accessory spleen. Med Pediatr Oncol 2001; 37 (2): 138-9.

30. Jacobs A., Lenoir P., Delree M., Ramet J., Piepsz A. Unusual Tc-99m MDP and I-123 MIBG images in focal pyelonephritis. Clin Nucl Med 1990; 15 (11): 821-4.

31. Frappaz D., Giammarile F., Thiesse P., et al. False positive MIBG scan. Med Pediatr Oncol 1997; 29 (6): 589-92.

32. Rottenburger C., Juettner E., Harttrampf A.C., Hentschel M., Kontny U., Roessler J. False-positive radio-iodinated metaiodobenzylguanidine (123I-MIBG) accumulation in a mast cell-in filtrated infantile haemangioma. Br J Radiol 2010; 83 (992): e168-e171.

33. DuBois S.G., London W.B., Zhang Y., Matthay K.K., et al. Lung metastases in neuroblastoma at initial diagnosis: A report from the International Neuroblastoma Risk Group (INRG) project. Pediatr Blood Cancer. 2008; 51 (5): 589-92.

Pediatric Hematology/Oncology and Immunopathology. 2018; 17: 92-102

Lung metastases in childhood neuroblastoma

Shamanskaya T. V., Kachanov D. Y., Lihotkina V. I., Tereschenko G. V., Ternovaya E. S., Shcherbakov A. P., Likar Y. N., Roschin V. Y., Olshanskaya Y. V., Kazakova A. N., Varfolomeeva S. R.

https://doi.org/10.24287/1726-1708-2018-17-2-92-102

Abstract

Lung metastases in patients with neuroblastoma (NB) are an extremely rare situation. Such patients have a worse prognosis and more aggressive clinical behavior of the underlying disease. This article presents an analysis of the epidemiological, clinical, radiologic features and prognosis of the disease in a group of patients with stage 4 NB and lung metastases. The cohort of NB patients with stage 4 according to the International Neuroblastoma Staging System (INSS) treated in NRC PHOI named after Dmitry Rogachev for the period 01.2012–12.2016 (60 months) was included in the analysis. Patients were stratified and treated according to the modified protocol NB-2004. Comparative analysis of patients with high-risk NB with and without lung metastases was done. Estimated event-free and overall survival were determined using Kaplan–Meier methods. Among 132 patients with stage 4 NB lung metastases were detected in 10 cases, which represented 7.5% of the whole group. The median age of the patients with lung metastases was 26.4 months (range 4.3–92.5). 9 (90%) patients were stratified to highrisk group, 1 (10%) to intermediate risk group. Comparative analysis of patients with stage 4 high-risk NB with and without lung metastases showed no statistical difference in comparison by sex, age, localization of the primary tumor, MYCN status, and the number of metastatic compartments. Progression during induction therapy was more frequent in patients with lung metastases (p = 0.02). 2-year overall survival (OS) in the group of patients with lung metastases was lower than in group without metastases to the lung (50.0 ± 15.8% vs 75.9 ± 3.9%, p = 0.045). In our study, the presence of lung metastases was more common than was described elsewhere and is clinically important because it portends a poor prognosis.

References

1. Goodman M.T., Gurney J.G., Smith M.A., Olsham A.F. Sympathetic nervous system tumors. In: Ries L.AG., Smith M.A., Gurney J.G., et al, eds. ancer incidence and survival amoung children and adolescents: United States SEER Program 1975-1995. Bethesda, Md: National Cancer Institute 1999; 65-72.

2. Berthold F., Simon T. Clinical presentation. In: Neuroblastoma. Cheung N.K., Cohn S. eds. Springer-Verlag, Berlin, Heidelberg; 2005:63-86.

3. Brodeur G.M., Pritchard J., Berthold F., Carlsen N.L., Castel V., Castelberry R.P., et al. Revisions of the international criteria for neuroblastoma diagnosis, staging, and response to treatment. J Clin Oncol. 1993; 11(8): 1466-77.

4. Shimada H., Umehara S., Monobe Y., Hachitanda Y., Nakagawa A., Goto S., et al. International neuroblastoma pathology classification for prognostic evaluation of patients with peripheral neuroblastic tumors: a report from the Children's Cancer Group. Cancer 2001; 92 (9): 2451-61.

5. NB2004 protocol. Berthold F (principal investigator). http://www.kinderkrebsinfo.de/ dlja_specialistov/protokoly_gpoh/pohkinderkrebsinfotherapiestudien/nb2004/ index_rus.html [cited 2016 March 15].

6. DuBois S.G., Kalika Y., Lukens J.N., Brodeur G.M., et al. Metastatic sites in stage IV and IVS neuroblastoma correlate with age, tumor biology, and survival. J Pediatr Hematol Oncol 1999 May-Jun; 21 (3): 181-9.

7. Kammen B.F., Matthay K.K., Pacharn P., Gerbing R., et al. Pulmonary metastases at diagnosis of neuroblastoma in pediatric patients: CT findings and prognosis. AJR Am J Roentgenol. 2001 Mar;176(3):755-9.

8. Cowie F., Corbett R., Pinkerton C.R. Lung involvement in neuroblastoma: incidence and characteristics. Med Pediatr Oncol. 1997 Jun; 28(6): 429-32.

9. Brisse H.J., McCarville M.B., Grana-ta C., Krug K.B., Wootton-Gorges S.L., Kanegawa K., Giammarile F., et al. Guidelines for imaging and staging of neuroblastic tumors: consensus report from the International Neuroblastoma Risk Group Project International Neuroblastoma Risk Group Project. Radiology 2011; 261 (1): 243-57.

10. De la Monte S.M., Moore G.W., Hutchins G.M. Nonrandom distribution of metastases in neuroblastic tumors. Cancer 1983 Sep 1; 52 (5): 915-25.

11. Stigall R., Smith W.L., Franken E.A., Smith J.A., Crussi F.G. Intrapulmonic metastatic neuroblastoma. Ann Radiol (Paris). 1979 Mar-Apr; 22 (2-3): 223-7.

12. Towbin R., Gruppo R.A. Pulmonary metastases in neuroblastoma. AJR Am J Roentgenol 1982 Jan; 138 (1): 75-8.

13. Seo J.B., Im J.G., Goo J.M., Chung M.J., Kim M.Y. Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics 2001 Mar-Apr; 21 (2): 403-17.

14. Vik T.A., Pfluger T., Kadota R., Castel V., Tulchinsky M., Farto J.C., et al. (123)I-mIBG scintigraphy in patients with known or suspected neuroblastoma: Results from a prospective multicenter trial. Pediatr Blood Cancer 2009; 52: 784-90.

15. Sharp S.E., Gelfand M.J., Shulkin B.L. Pediatrics: diagnosis of neuroblastoma. Semin Nucl Med 2011; 41: 345-53.

16. Vallabhajosula S., Nikolopoulou A. Radioiodinated metaiodobenzylguanidine (MIBG): radiochemistry, biology, and pharmacology. Semin Nucl Med 2011; 41 (5): 324-33.

17. Yanik G.A., Parisi M.T., Shulkin B.L., et al. Semiquantitative mIBG scoring as a prognostic indicator in patients with stage 4 neuroblastoma: a report from the Children’s Oncology Group. J Nucl Med 2013; 54 (4): 541-8.

18. Nakajo M., Shapiro B., Copp J., et al. The normal and abnormal distribution of the adrenomedullary imaging agent m-[I-131] iodobenzylguanidine (I-131 MIBG) in man: evaluation by scintigraphy. J Nucl Med 1983; 24 (8): 672-82.

19. Parisi M.T., Sandler E.D., Hattner R.S. The biodistribution of metaiodobenzylguanidine. Semin Nucl Med 1992; 22 (1): 46-8.

20. Okuyama C., Sakane N., Yoshida T., et al. (123)I- or (125) I-metaiodobenzylgu-anidine visualization of brown adipose tissue. J Nucl Med 2002;43(9): 1234-40.

21. Okuyama C., Ushijima Y., Kubota T., et al. 123I-metaiodobenzylguanidine uptake in the nape of the neck of children: likely visualization of brown adipose tissue. J Nucl Med 2003; 44 (9): 1421-5.

22. Gelfand M.J. 123I-MIBG uptake in the neck and shoulders of a neuroblastoma patient: damage to sympathetic innerva-tion blocks uptake in brown adipose tissue. Pediatr Radiol 2004; 34 (7): 577-9.

23. Bonnin F., Lumbroso J., Tenenbaum F., Hartmann O., Parmentier C. Refining interpretation of MIBG scans in children. J Nucl Med 1994; 35 (5): 803-10.

24. Paltiel H.J., Gelfand M.J., Elgazzar A.H., et al. Neural crest tumors: I-123 MIBG imaging in children. Radiology 1994; 190(1): 117-21.

25. Acharya J., Chang P.T., Gerard P. Abnormal MIBG uptake in a neuroblastoma patient with right upper lobe atelectasis. Pediatr Radiol 2012; 42 (10): 1259-62.

26. Schindler T., Yu.C., Rossleigh M., Pereira J., Cohn R. False-positive MIBG uptake in pneumonia in a patient with stage IV neuroblastoma. Clin Nucl Med 2010; 35 (9): 743-5.

27. Kulatunge C.R., Son H. False-positive 123I-MIBG scintigraphy due to multiple focal nodular hyperplasia. Clin Nucl Med 2013; 38 (12): 976-8.

28. Yang J., Codreanu I., Servaes S., Zhu-ang H. Persistent intense MIBG activity in the liver caused by prior radiation. Clin Nucl Med 2014; 39 (10): 926-30.

29. Granata C., Carlini C., Conte M., Claudi-ani F., Campus R., Rizzo A. False positive MIBG scan due to accessory spleen. Med Pediatr Oncol 2001; 37 (2): 138-9.

30. Jacobs A., Lenoir P., Delree M., Ramet J., Piepsz A. Unusual Tc-99m MDP and I-123 MIBG images in focal pyelonephritis. Clin Nucl Med 1990; 15 (11): 821-4.

31. Frappaz D., Giammarile F., Thiesse P., et al. False positive MIBG scan. Med Pediatr Oncol 1997; 29 (6): 589-92.

32. Rottenburger C., Juettner E., Harttrampf A.C., Hentschel M., Kontny U., Roessler J. False-positive radio-iodinated metaiodobenzylguanidine (123I-MIBG) accumulation in a mast cell-in filtrated infantile haemangioma. Br J Radiol 2010; 83 (992): e168-e171.

33. DuBois S.G., London W.B., Zhang Y., Matthay K.K., et al. Lung metastases in neuroblastoma at initial diagnosis: A report from the International Neuroblastoma Risk Group (INRG) project. Pediatr Blood Cancer. 2008; 51 (5): 589-92.