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Intracranial Relapse in Pediatric Sarcoma.

Danielle E Smith1, Tyler Hamby1,2, Kenneth Heym3

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Pediatric sarcoma relapse in the central nervous system, including rare infantile fibrosarcoma brain metastasis, is increasing. Early neurological screening may improve detection of intracranial relapse in sarcoma patients.

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Area of Science:

  • Pediatric Oncology
  • Neuro-oncology
  • Cancer Metastasis

Background:

  • Pediatric sarcoma patient outcomes have improved due to advances in treatment and imaging.
  • Despite improvements, approximately one-third of patients experience disease relapse.
  • Intracranial metastasis in pediatric sarcoma was historically rare but appears to be increasing, associated with poor prognosis.

Purpose of the Study:

  • To illustrate the central nervous system as a potential site for pediatric sarcoma relapse.
  • To investigate patterns of central nervous system relapse in pediatric sarcoma.
  • To highlight the potential for early detection of neurological manifestations.

Main Methods:

  • Retrospective review of 3 deidentified pediatric sarcoma patient charts.
  • Analysis of treatment regimens, including targeted therapies (entrectinib, Ruxolitnib, pazopanib).
  • Examination of clinical presentation and diagnostic findings related to central nervous system relapse.

Main Results:

  • Demonstrated central nervous system relapse as a possibility in pediatric sarcoma.
  • Reported the first case of infantile fibrosarcoma brain metastasis and a rare case of sarcoma lymph node metastasis.
  • Observed a lag in detection of intracranial relapse, with neurological symptoms preceding diagnosis in some cases.

Conclusions:

  • The central nervous system is a potential site for pediatric sarcoma relapse.
  • Early identification of neurological symptoms is crucial for timely diagnosis of intracranial metastasis.
  • Implementing a focused review of systems for neurological manifestations could aid in early screening for brain metastasis.