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Brain metastases in pediatric Ewing sarcoma and rhabdomyosarcoma: the St. Jude Children's Research Hospital
S Parasuraman1, J Langston, B N Rao
1Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
Insights
Brain metastases are rare in pediatric Ewing sarcoma (ES) and rhabdomyosarcoma (RMS), carrying a grave prognosis. Combined-modality treatment offers the best chance for long-term survival in these rare pediatric brain tumor cases.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Cancer Metastasis
Background:
- Brain metastases are uncommon in pediatric solid tumors.
- Ewing sarcoma (ES) and rhabdomyosarcoma (RMS) are among the pediatric cancers with a higher propensity for brain metastasis.
- Understanding the characteristics and outcomes of these metastases is crucial for treatment strategies.
Purpose of the Study:
- To review the institutional experience with brain metastases in pediatric patients with ES and RMS.
- To analyze the clinical characteristics, treatment modalities, and outcomes of these patients.
- To inform clinical decision-making regarding the management of pediatric brain metastases.
Main Methods:
- Retrospective review of patients treated at St. Jude Children's Research Hospital over 36 years.
- Inclusion criteria: patients with ES or RMS and confirmed brain metastases.
- Data collected included clinical presentation, therapy, and survival outcomes.
Main Results:
- Brain metastases occurred in 2.4% of RMS patients (10/419) and 3.3% of ES patients (11/335).
- The median age at diagnosis was 10.4 years; all patients presented with central nervous system (CNS) involvement.
- Survival was poor, with a median survival of 2.7 months post-metastasis diagnosis and a 1-year survival of 23.8% +/- 8.5%.
Conclusions:
- Brain metastases in pediatric ES and RMS are rare but associated with a poor prognosis.
- Routine imaging for asymptomatic children is not recommended due to the rarity and presence of neurological signs at diagnosis.
- Combined-modality treatment, including chemotherapy, surgery, and radiotherapy, offers the best potential for long-term survival.
Purpose:
Although brain metastases rarely occur in children with solid tumors, pediatric Ewing sarcoma (ES) and rhabdomyosarcoma (RMS) are among those most likely to metastasize to the brain. The authors review their institution's experience of brain metastases of ES and RMS.
Patients And Methods:
The clinical characteristics, therapy, and outcome of all patients treated at St. Jude Children's Research Hospital over a 36-year period who had ES or RMS with brain metastases were reviewed.
Results:
Of 419 patients with RMS, 10 (2.4%) had brain metastases. Of 335 patients with ES, 11 (3.3%) had brain metastases. The median age of the 21 patients was 10.4 years (range, 0.4-18.0 years) at the time of primary diagnosis. All had clinical signs of central nervous system (CNS) involvement. Outcome was dismal: The median duration of survival after diagnosis of brain metastasis was 2.7 months. The estimated survival 1 year after detection of brain involvement was 23.8%+/-8.5% (mean +/- standard error). One patient, who underwent chemotherapy, surgical resection, and radiotherapy, at the time of this writing is a long-term survivor.
Conclusions:
Brain metastases are rare in children with ES and RMS, but carry a grave prognosis. Because most brain metastases are accompanied by signs of neurologic involvement, routine imaging studies of asymptomatic children are not necessary. Combined-modality treatment offers the best chance of long-term survival.