Malignant ovarian germ cell tumors in pediatric patients: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) study

Objective: Malignant ovarian germ cell tumors (MOGCT) carry an excellent prognosis, and the treatment aims to achieve results with the least possible treatment-related morbidity. The aim of this study was to assess the outcomes of pediatric patients with MOGCT. Methods: Patients were treated according to their stage: surgery and surveillance for stage I; a modified bleomycin\u2013etoposide\u2013cisplatin (BEP) regimen for stages II (three cycles), III, and IV (three cycles) with surgery on residual disease. Results: Seventy-seven patients were enrolled (median age 11.8 years), 26 with dysgerminoma (Dysg), 13 with immature teratoma and elevated serum alpha-fetoprotein levels (IT+AFP), and 38 with nondysgeminoma (Non-Dysg) staged as follows: 27 stage I, 13 stage II, 32 stage III, 5 stage IV. Among evaluable patients in stage I (5-year event-free survival [EFS] 72.1% [95% CI: 56.4\u201392.1%]; 5-year overall survival [OS] 100%), seven relapsed (three patients with Dysg and four patients with Non-Dysg) and were rescuedwith chemotherapy (plus surgery in three patients). Among the evaluable patients with stages II\u2013IV, 48 (98%) achieved complete remission after chemotherapy \ub1 surgery, one (IT + AFP, stage IV) had progressive disease. In the whole series (median follow-up 80 months), the 5-year OS and EFS were 98.5% (95% CI: 95.6\u2013100%) and 84.5% (95% CI: 76.5\u2013 93.5%). Conclusions:We confirm the excellent outcome for MOGCT. Robust data are lacking on surgical staging, surveillance for Non-Dysg with stage I, the management of IT + AFP, and the most appropriate BEP regimen. As pediatric oncologists,we support the role of surveillance after proper surgical staging providing cases are managed by experts at specialized pediatric centers

Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors: report from the Children's Oncology Group

PURPOSE: To determine whether overall survival (OS) can be preserved for patients with stage I pediatric malignant ovarian germ cell tumor (MOGCT) with an initial strategy of surveillance after surgical resection. PATIENTS AND METHODS: Between November 2003 and July 2011, girls age 0 to 16 years with stage I MOGCT were enrolled onto Children's Oncology Group study AGCT0132. Required histology included yolk sac, embryonal carcinoma, or choriocarcinoma. Surveillance included measurement of serum tumor markers and radiologic imaging at defined intervals. In those with residual or recurrent disease, chemotherapy with compressed PEB (cisplatin, etoposide, and bleomycin) was initiated every 3 weeks for three cycles (cisplatin 33 mg/m(2) on days 1 to 3, etoposide 167 mg/m(2) on days 1 to 3, bleomycin 15 U/m(2) on day 1). Survivor functions for event-free survival (EFS) and OS were estimated using the Kaplan-Meier method. RESULTS: Twenty-five girls (median age, 12 years) with stage I MOGCT were enrolled onto AGCT0132. Twenty-three patients had elevated alpha-fetoprotein (AFP) at diagnosis. Predominant histology was yolk sac. After a median follow-up of 42 months, 12 patients had evidence of persistent or recurrent disease (4-year EFS, 52%; 95% CI, 31% to 69%). Median time to recurrence was 2 months. All patients had elevated AFP at recurrence; six had localized disease, two had metastatic disease, and four had tumor marker elevation only. Eleven of 12 patients experiencing relapse received successful salvage chemotherapy (4-year OS, 96%; 95% CI, 74% to 99%). CONCLUSION: Fifty percent of patients with stage I pediatric MOGCT can be spared chemotherapy; treatment for those who experience recurrence preserves OS. Further study is needed to identify the factors that predict recurrence and whether this strategy can be extended successfully to older adolescents and young adults

Impact of central surgical review in a study of malignant germ cell tumors

BACKGROUND: Verification of surgical staging has received little attention in clinical oncology trials. Central surgical review was undertaken during a study of malignant pediatric germ cell tumors. METHODS: Children's Oncology Group study AGCT0132 included central surgical review during the study. Completeness of submitted data and confirmation of assigned stage were assessed. Review responses were: assigned status confirmed, assignment withheld pending review of additional information requested, or institutional assignment of stage disputed with explanation given. Changes in stage assignment were at the discretion of the enrolling institution. RESULTS: A total of 206 patients underwent central review. Failure to submit required data elements or need for clarification was noted in 40%. Disagreement with stage assignment occurred in 10% with 17/21 discordant patients reassigned to stage recommended by central review. Four ovarian tumor patients not meeting review criteria for Stage I remained in that stratum by institutional decision. Two-year event free survival in Stage I ovarian patients was 25% for discordant patients compared to 57% for those meeting Stage I criteria by central review. CONCLUSIONS: Central review of stage assignment improved complete data collection and assignment of correct tumor stage at study entry, and allowed for prompt initiation of chemotherapy in patients determined not to have Stage I disease

Distributed visualization of gridded geophysical data: the Carbon Data Explorer, version 0.2.3

Due to the proliferation of geophysical models, particularly climate models, the increasing resolution of their spatiotemporal estimates of Earth system processes, and the desire to easily share results with collaborators, there is a genuine need for tools to manage, aggregate, visualize, and share data sets. We present a new, web-based software tool – the Carbon Data Explorer – that provides these capabilities for gridded geophysical data sets. While originally developed for visualizing carbon flux, this tool can accommodate any time-varying, spatially explicit scientific data set, particularly NASA Earth system science level III products. In addition, the tool\u27s open-source licensing and web presence facilitate distributed scientific visualization, comparison with other data sets and uncertainty estimates, and data publishing and distribution

Retrograde gastroesophageal intussusception: Initial presenting feature of achalasia in a teenager

A 16-year-old Caucasian male presented with acute vomiting and dysphagia. Imaging studies revealed retrograde gastroesophageal intussusception (RGEI), which reduced prior to diagnostic laparoscopy. No clear etiology for RGEI was identified at that time, so further surgical intervention was deferred. He returned several months later with persistent dysphagia. Imaging, endoscopy, and endoluminal function imaging probe then diagnosed achalasia. He underwent a second laparoscopy for Heller myotomy and Dor fundoplication. This is the first report of RGEI preceding a diagnosis of achalasia

Successful treatment of a solitary skull metastasis in a child with Wilms' Tumor

This report presents the successful treatment of a child with a solitary metastatic lesion to the calvarium following treatment for Stage III anaplastic Wilms’ Tumor

Rapid response tools and datasets for post-fire modeling: linking Earth Observations and process-based hydrological models to support post-fire remediation

Preparation is key to utilizing Earth Observations and process-based models to support post-wildfire mitigation. Post-fire flooding and erosion can pose a serious threat to life, property and municipal water supplies. Increased runoff and sediment delivery due to the loss of surface cover and fire-induced changes in soil properties are of great concern. Remediation plans and treatments must be developed and implemented before the first major storms in order to be effective. One of the primary sources of information for making remediation decisions is a soil burn severity map derived from Earth Observation data (typically Landsat) that reflects fire induced changes in vegetation and soil properties. Slope, soils, land cover and climate are also important parameters that need to be considered. Spatially-explicit process-based models can account for these parameters, but they are currently under-utilized relative to simpler, lumped models because they are difficult to set up and require spatially-explicit inputs (digital elevation models, soils, and land cover). Our goal is to make process-based models more accessible by preparing spatial inputs before a fire, so that datasets can be rapidly combined with soil burn severity maps and formatted for model use. We are building an online database (http://geodjango.mtri.org/geowepp /) for the continental United States that will allow users to upload soil burn severity maps. The soil burn severity map is combined with land cover and soil datasets to generate the spatial model inputs needed for hydrological modeling of burn scars. Datasets will be created to support hydrological models, post-fire debris flow models and a dry ravel model. Our overall vision for this project is that advanced GIS surface erosion and mass failure prediction tools will be readily available for post-fire analysis using spatial information from a single online site

Distributed visualization of gridded geophysical data: the Carbon Data Explorer, version 0.2.3

Due to the proliferation of geophysical models, particularly climate models, the increasing resolution of their spatiotemporal estimates of Earth system processes, and the desire to easily share results with collaborators, there is a genuine need for tools to manage, aggregate, visualize, and share data sets. We present a new, web-based software tool – the Carbon Data Explorer – that provides these capabilities for gridded geophysical data sets. While originally developed for visualizing carbon flux, this tool can accommodate any time-varying, spatially explicit scientific data set, particularly NASA Earth system science level III products. In addition, the tool's open-source licensing and web presence facilitate distributed scientific visualization, comparison with other data sets and uncertainty estimates, and data publishing and distribution