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国立がん研究センター 中央病院

Home > Clincal depts. > Department of Pediatric Oncology

Department of Pediatric Oncology

Chitose Ogawa, Tadashi Kumamoto, Yuki Aoki, Ayumu Arakawa, Yasuhiro Fujiwara, Hiroshi Kawamoto, Ako Hosono, Naoko Yasui, Hide Kaneda 

Introduction

Pediatric oncology includes a wide variety of malignancies in children and adolescents such as acute leukemia and malignant lymphoma, as well as solid tumors including osteosarcoma, soft tissue sarcoma, neuroblastoma, liver tumor and retinoblastoma. Many diseases are usually chemosensitive and curable with appropriate treatment. The common approach to these diseases is a “risk-adapted therapy” strategy considering long-term life expectancy. In the Department of Pediatric Oncology, patients with pediatric malignancies are managed by four pediatric oncologists and a pediatric surgeon. Although pediatric oncologists mainly treat and manage patients, a multidisciplinary team approach including radiation oncologists, orthopedic surgeons, ophthalmologic surgeons and others is incorporated for the treatment. To achieve treatment completion and optimal quality of hospital life for children, pediatric nurse specialists, teachers, child care staff, psychologists and psychiatrists also join our team. For young patients, educational opportunities ranging from elementary school to high school are available in the pediatric ward, where seven teachers work daily.

Routine activities

We deal with 50-80 new patients every year. Our daily activity in the pediatric outpatient clinic is to manage new patients, to treat patients with chemotherapy or blood transfusions and to provide follow-up care for patients who have completed intensive treatment. Patients receive multidisciplinary therapy, including surgical removal of tumors, radiation therapy, chemotherapy, and sometimes stem cell transplantation (SCT), as indicated.

A Pediatric Conference is held every morning, mainly to decide on individual treatment plans. The pediatric staff and trainees discuss various issues regarding pediatric inpatients on daily rounds. Inter-department conferences in cooperation with orthopedics, radiation oncology, and palliative care are individually scheduled every two weeks.

Research activities

  1. For newly diagnosed patients, we participate in several multicenter studies in the Japan Children's Cancer Group (JCCG), including those by the Japan Ewing Sarcoma Study Group (JESS), the Japan Rhabdomyosarcoma Study Group (JRSG) and the Japanese Pediatric Leukemia/Lymphoma Study Group (JPLSG). In addition, we also conduct our own clinical trials.
  2. For relapsed patients, we are actively involved in the development of new drugs and treatments including off-label and unapproved medications.
  3. For patients with veno-occlusive disease in stem cell transplantation and patients with delayed excretion of methotrexate, a phase II registration trial of defibrotide and glucarpidase are conducted.
  4. For provision of a similar environment during the treatment to that of before patients' disease onset, we plan to construct a medical care system through the use of appropriate medical and social resources in their local communities.

Clinical trials

In 2015, we conducted 12 trials, including early phase trials, an international study and cooperative studies. The five trials (1, 4, 6, 7 and 12) are investigator-initiated registration-directed clinical trials conducted under the Pharmaceutical Affairs Law in Japan. Two international cooperative trials are ongoing: in the No. 10 trial, we are collaborating with the International BFM group in Europe and in the No. 12 trial with the Children's Oncology Group in the USA.

  1. A phase II trial of glucarpidase for patients who were treated with high-dose methotrexate resulting in delayed excretion.
  2. A phase Ib study of 131I-metaiodobenzylguanidine (MIBG) therapy with valproic acid (VPA) for high risk or recurrent neuroblastoma
  3. A phase Ib study of VPA and 13-cis-RA (isotretinoin) combination therapy for advanced and recurrent neuroblastoma.
  4. A feasibility trial of ch14.18 combined with IL-2 and various colony-stimulating factors for recurrent neuroblastoma.
  5. A phase I trial of immunotherapy using HLA-A2-and A24-restricted glypican-3 peptide vaccine for pediatric tumors.
  6. Efficacy and safety study of defibrotide (DF) for the treatment of veno-occlusive disease (VOD).
  7. Efficacy and safety study of defibrotide (DF) for the prophylaxis of veno-occlusive disease (VOD).
  8. The Japanese Pediatric Leukemia/Lymphoma Study Group (JPLSG) ALL-T11 and the Japan Adult Leukemia Study Group (JALSG) T-ALL-211-U ALL-T11: A Multi-Center Phase II Study in Children and Adolescents with Newly Diagnosed T-cell Acute Lymphoblastic Leukemia
  9. The Japanese Pediatric Leukemia/Lymphoma Study Group (JPLSG) ALL-B12: A Multi-Center Phase II/III Study in Children with Newly Diagnosed B-cell Precursor Acute Lymphoblastic Leukemia
  10. An International Study for Treatment of Standard Risk Childhood Relapsed ALL 2010 (IntReALL SR 2010): A randomized Phase III Study Conducted by the Resistant Disease Committee of the International BFM Study Group
  11. A Multi-Center Seamless Phase II-III Randomized Trial of High-dose Cytarabine in Initial Induction with Evaluation of Flowcytometry- based Minimal Residual Disease for Children with de Novo Acute Myeloid Leukemia (AML-12)
  12. Treatment of Children with All Stages of Hepatoblastoma with Temsirolimus Added to High Risk Stratum Treatment: A Phase III Study

Education

We provide personnel training and education for the skills of diagnosis and management for pediatric hematological malignancies and solid tumors. Residents also learn the skills to treat not only newly diagnosed patients but also relapsed or refractory patients by global standard therapy. In addition, senior residents acquire the ability to plan studies for new agents or new therapies, which we regard as an important role of this center.

Future prospects

We promote the development of therapies for pediatric malignancies as a top priority. For this mission, we lead the planning of clinical or registration trials in cooperation with domestic and international centers as a core institution in Japan.

Our other mission is to provide individualized medicine for children with cancer. For this aim, we plan to expand the subjects in the comprehensive genetic testing project in our center to the pediatric age group. In addition, we promote clinical trials using molecular targeted agents for pediatric malignancies.


Table 1. Number of patients in 2015 Table 2. Type of procedure 

List of papers published in 2015

Journal

  1. Yoshida A, Asano N, Kawai A, Kawamoto H, Nakazawa A, Kishimoto H, Kushima R. Differential SALL4 immunoexpression in malignant rhabdoid tumours and epithelioid sarcomas. Histopathology, 66:252-261, 2015
  2. Yasui N, Yoshida A, Kawamoto H, Yonemori K, Hosono A, Kawai A. Clinicopathologic analysis of spindle cell/sclerosing rhabdomyosarcoma. Pediatr Blood Cancer, 62:1011-1016, 2015
  3. Ono R, Hasegawa D, Hirabayashi S, Kamiya T, Yoshida K, Yonekawa S, Ogawa C, Hosoya R, Toki T, Terui K, Ito E, Manabe A. Acute megakaryoblastic leukemia with acquired trisomy 21 and GATA1 mutations in phenotypically normal children. Eur J Pediatr, 174:525-531, 2015
  4. Kato M, Manabe A, Saito AM, Koh K, Inukai T, Ogawa C, Goto H, Tsuchida M, Ohara A. Outcome of pediatric acute lymphoblastic leukemia with very late relapse: a retrospective analysis by the Tokyo Children's Cancer Study Group (TCCSG). Int J Hematol, 101:52-57, 2015
  5. Mori M, Imaizumi M, Ishiwada N, Kaneko T, Goto H, Kato K, Hara J, Kosaka Y, Koike K, Kawamoto H, Maeda N, Yoshinari T, Kishino H, Takahashi K, Kawahara S, Kartsonis NA, Komada Y. Pharmacokinetics, efficacy, and safety of caspofungin in Japanese pediatric patients with invasive candidiasis and invasive aspergillosis. J Infect Chemother, 21:421-426, 2015
  6. Kinuya S, Yoshinaga K, Higuchi T, Jinguji M, Kurihara H, Kawamoto H. Draft guidelines regarding appropriate use of (131)I-MIBG radiotherapy for neuroendocrine tumors : Guideline Drafting Committee for Radiotherapy with (131)I-MIBG, Committee for Nuclear Oncology and Immunology, The Japanese Society of Nuclear Medicine. Ann Nucl Med, 29:543-552, 2015
  7. Yasui N, Kawamoto H, Fujiwara M, Aihara Y, Ogawa C, Hosono A, Suzuki S. High-dose chemotherapy for high-risk retinoblastoma: clinical course and outcome of 14 cases in the National Cancer Center, Japan. Bone Marrow Transplant, 50:221- 224, 2015