title: Atypical teratoid/rhabdoid tumors (ATRT): improved survival in children 3 years of age and older with radiation therapy and high-dose alkylator-based chemotherapy.
abstract: OBJECTIVE
  To describe clinical features, therapeutic approaches, and prognostic factors in pediatric patients with atypical teratoid/rhabdoid tumors (ATRT) treated at St Jude Children's Research Hospital (SJCRH).
  
  
  METHODS
  Primary tumor samples from patients diagnosed with ATRT at SJCRH between July 1984 and June 2003 were identified. Pathology review included histologic, immunohistochemical analysis, and fluorescence in situ hybridization for SMARCB1 (also known as hSNF5/INI1) deletion. Clinical records of patients with pathologic confirmation of ATRT were reviewed.
  
  
  RESULTS
  Thirty-seven patients were diagnosed with ATRT at SJCRH during the 19-year study interval. Six patients were excluded from this clinical review based on pathologic or clinical criteria. Of the remaining 31 patients, 22 were younger than 3 years. Posterior fossa primary lesions and metastatic disease at diagnosis were more common in younger patients with ATRT. All patients underwent surgical resection; 30 received subsequent chemotherapy. The majority of patients aged 3 years or older received postoperative craniospinal radiation. Two-year event-free (EFS) and overall survival (OS) of children aged 3 years or older (EFS, 78% + 14%; OS, 89% +/- 11%) were significantly better than those for younger patients (EFS, 11% +/- 6%; OS, 17% +/- 8%); EFS, P = .009 and OS, P = .0001. No other clinical characteristics were predictive of survival. Three of four patients 3 years or older with progressive disease were successfully rescued with ifosfamide, carboplatin, and etoposide therapy.
  
  
  CONCLUSIONS
  Children presenting with ATRT before the age of 3 years have a dismal prognosis. ATRT presenting in older patients can be cured using a combination of radiation and high-dose alkylating therapy. Older patients with relapsed ATRT can have salvage treatment using ICE chemotherapy.
authors.affiliation: Department of Hematology-Oncology, Mail Stop 260, St Jude Children's Research Hospital, 332 N Lauderdale St, Memphis, TN 38105, USA.
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Tekautz
authors.forename: Christine E
authors.initials: CE
authors.lastname: Fuller
authors.forename: Susan
authors.initials: S
authors.lastname: Blaney
authors.forename: Maryam
authors.initials: M
authors.lastname: Fouladi
authors.forename: Alberto
authors.initials: A
authors.lastname: Broniscer
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.forename: Matthew
authors.initials: M
authors.lastname: Krasin
authors.forename: James
authors.initials: J
authors.lastname: Dalton
authors.forename: Gregory
authors.initials: G
authors.lastname: Hale
authors.forename: Larry E
authors.initials: LE
authors.lastname: Kun
authors.forename: Dana
authors.initials: D
authors.lastname: Wallace
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gilbertson
authors.forename: Amar
authors.initials: A
authors.lastname: Gajjar
mesh_terms: D016543:Central Nervous System Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D007223:Infant; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D018335:Rhabdoid Tumor / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D013724:Teratoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D014157:Transcription Factors / Q000032:analysis
chemical_list: C101681:SMARCC1 protein, human; D014157:Transcription Factors