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Journal of Neuro-Oncology

, Volume 81, Issue 1, pp 97–111 | Cite as

Atypical teratoid/rhabdoid tumor: the controversy behind radiation therapy

  • Sarah E. Squire
  • Michael D. Chan
  • Karen J. Marcus
Editor's Invited Manuscript-Invit.Only

Abstract

To date, approximately 200 cases of atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system have been described in the literature. This CNS tumor tends to present at an age of less than 3 years, and most patients succumb to their disease within 1 year of diagnosis. Prior to the rise in utilization of immunohistochemical (IHC) testing in the late 1990s, this tumor was likely mistaken as medulloblastoma and treated as such. However, lessons learned from regimens based upon medulloblastoma have revealed that AT/RT requires more aggressive treatment. A significant portion of patients die of local recurrence in spite of aggressive surgery and chemotherapy. As most patients with AT/RT present as infants or young children, radiation therapy has been a less than standard treatment option. However, recent evidence suggests that long-term survival can occur with use of more aggressive treatment approaches including dose-intense chemotherapy as well as adjuvant radiation therapy. A standardized and effective approach to treating this usually fatal tumor remains elusive, and the role of radiation therapy presents a particular dilemma as young patients with this disease may experience devastating late effects of therapy if they achieve a long-term survival. Review of the literature reveals an association between initial radiation therapy and the ability to achieve a prolonged survival. Our review underscores the importance or enrolling patients in multi-institutional prospective studies to further investigate the value of radiation to treat this pediatric neoplasm.

Keywords

Atypical teratoid/rhabdoid tumor (AT/RT) CNS tumor Pediatric Radiation therapy 

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References

  1. 1.
    Beckwith JB, Palmer NF (1978) Histopathology and prognosis of wilms tumors: results from the first national wilms’ tumor study. Cancer 41(5):1937–1948PubMedCrossRefGoogle Scholar
  2. 2.
    Packer RJ, Biegel JA, Blaney S et al (2002) Atypical teratoid/rhabdoid tumor of the central nervous system: report on workshop. J Pediatr Hematol Oncol 24(5):337–342PubMedCrossRefGoogle Scholar
  3. 3.
    Parwani AV, Stelow EB, Pambuccian SE et al (2005) Atypical teratoid/rhabdoid tumor of the brain: cytopathologic characteristics and differential diagnosis. Cancer 105(2):65–70PubMedCrossRefGoogle Scholar
  4. 4.
    Lee MC, Park SK, Lim JS et al (2002) Atypical teratoid/rhabdoid tumor of the central nervous system: clinico-pathological study. Neuropathology 22(4):252–260PubMedCrossRefGoogle Scholar
  5. 5.
    Bambakidis NC, Robinson S, Cohen M et al (2002) Atypical teratoid/rhabdoid tumors of the central nervous system: clinical, radiographic and pathologic features. Pediatr Neurosurg 37(2):64–70PubMedCrossRefGoogle Scholar
  6. 6.
    Utsuki S, Oka H, Tanaka S et al (2003) Importance of re-examination for medulloblastoma and atypical teratoid/rhabdoid tumor. Acta Neurochir (Wien) 145(8):663–666, Discussion 666CrossRefGoogle Scholar
  7. 7.
    Rorke LB, Packer RJ, Biegel JA (1996) Central nervous system atypical teratoid/rhabdoid tumors of infancy and childhood: definition of an entity. J Neurosurg 85(1):56–65PubMedGoogle Scholar
  8. 8.
    Biegel JA, Kalpana G, Knudsen ES et al (2002) The role of INI1 and the SWI/SNF complex in the development of rhabdoid tumors: meeting summary from the workshop on childhood atypical teratoid/rhabdoid tumors. Cancer Res 62(1):323–328PubMedGoogle Scholar
  9. 9.
    Biegel JA, Rorke LB, Packer RJ et al (1990) Monosomy 22 in rhabdoid or atypical tumors of the brain. J Neurosurg 73(5):710–714PubMedCrossRefGoogle Scholar
  10. 10.
    Hilden JM, Meerbaum S, Burger P et al (2004) Central nervous system atypical teratoid/rhabdoid tumor: results of therapy in children enrolled in a registry. J Clin Oncol 22(14):2877–2884PubMedCrossRefGoogle Scholar
  11. 11.
    Zimmerman MA, Goumnerova LC, Proctor M et al (2005) Continuous remission of newly diagnosed and relapsed central nervous system atypical teratoid/rhabdoid tumor. J␣Neurooncol 72(1):77–84PubMedCrossRefGoogle Scholar
  12. 12.
    Burger PC, Yu IT, Tihan T et al (1998) Atypical teratoid/rhabdoid tumor of the central nervous system: a highly malignant tumor of infancy and childhood frequently mistaken for medulloblastoma: a pediatric oncology group study. Am J Surg Pathol 22(9):1083–1092PubMedCrossRefGoogle Scholar
  13. 13.
    Weinblatt M, Kochen J (1992) Rhabdoid tumor of the central nervous system. Med Pediatr Oncol 20(3):258Google Scholar
  14. 14.
    Olson TA, Bayar E, Kosnik E et al (1995) Successful treatment of disseminated central nervous system malignant rhabdoid tumor. J Pediatr Hematol Oncol 17(1):71–75PubMedCrossRefGoogle Scholar
  15. 15.
    Tekautz TM, Fuller CE, Blaney S et al (2005) Atypical teratoid/rhabdoid tumors (ATRT): improved survival in children 3 years of age and older with radiation therapy and high-dose alkylator-based chemotherapy. J Clin Oncol 23(7):1491–1499PubMedCrossRefGoogle Scholar
  16. 16.
    Duffner PK, Horowitz ME, Krischer JP et al (1993) Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumors. N Engl J Med 328(24):1725–1731PubMedCrossRefGoogle Scholar
  17. 17.
    Grill J, Sainte-Rose C, Jouvet A et al (2005) Treatment of medulloblastoma with postoperative chemotherapy alone: an SFOP prospective trial in young children. Lancet Oncol 6(8):573–580PubMedCrossRefGoogle Scholar
  18. 18.
    Chen YW, Wong TT, Ho DM et al (2006) Impact of radiotherapy for pediatric CNS atypical teratoid/rhabdoid tumor (single institute experience). Int J Radiat Oncol Biol Phys 64(4):1038–1043PubMedCrossRefGoogle Scholar
  19. 19.
    Weiss E, Behring B, Behnke J et al (1998) Treatment of primary malignant rhabdoid tumor of the brain: report of three cases and review of the literature. Int J Radiat Oncol Biol Phys 41(5):1013–1019PubMedCrossRefGoogle Scholar
  20. 20.
    St Clair WH, Adams JA, Bues M et al (2004) Advantage of protons compared to conventional X-ray or IMRT in the treatment of a pediatric patient with medulloblastoma. Int J␣Radiat Oncol Biol Phys 58(3):727–734PubMedCrossRefGoogle Scholar
  21. 21.
    Hilden JM, Watterson J, Longee DC et al (1998) Central nervous system atypical teratoid tumor/rhabdoid tumor: response to intensive therapy and review of the literature. J␣Neurooncol 40(3):265–275PubMedCrossRefGoogle Scholar
  22. 22.
    Hirth A, Pedersen PH, Wester K et al (2003) Cerebral atypical teratoid/rhabdoid tumor of infancy: long-term survival after multimodal treatment, also including triple intrathecal chemotherapy and gamma knife radiosurgery – case report. Pediatr Hematol Oncol 20(4):327–332PubMedGoogle Scholar
  23. 23.
    Giller CA, Berger BD, Pistenmaa DA et al (2005) Robotically guided radiosurgery for children. Pediatr Blood Cancer 45(3):304–310PubMedCrossRefGoogle Scholar
  24. 24.
    Chang EL, Selek U, Hassenbusch SJ III et al (2005) Outcome variation among “radioresistant” brain metastases treated with stereotactic radiosurgery. Neurosurgery 56(5):936–945, Discussion 936–945PubMedGoogle Scholar
  25. 25.
    Sheehan JP, Sun MH, Kondziolka D et al (2003) Radiosurgery in patients with renal cell carcinoma metastasis to the brain: long-term outcomes and prognostic factors influencing survival and local tumor control. J Neurosurg 98(2):342–349PubMedCrossRefGoogle Scholar
  26. 26.
    Gerosa M, Nicolato A, Foroni R (2003) The role of gamma knife radiosurgery in the treatment of primary and metastatic brain tumors. Curr Opin Oncol 15(3):188–196PubMedCrossRefGoogle Scholar
  27. 27.
    Hernandez L, Zamorano L, Sloan A et al (2002) Gamma knife radiosurgery for renal cell carcinoma brain metastases. J Neurosurg 97(5 suppl):489–493PubMedGoogle Scholar
  28. 28.
    Gonzalez-Martinez J, Hernandez L, Zamorano L et al (2002) Gamma knife radiosurgery for intracranial metastatic melanoma: a 6-year experience. J Neurosurg 97(5 Suppl):494–498PubMedGoogle Scholar
  29. 29.
    Duffner PK, Cohen ME, Thomas PR et al (1985) The long-term effects of cranial irradiation on the central nervous system. Cancer 56(7 Suppl):1841–1846PubMedCrossRefGoogle Scholar
  30. 30.
    Ris MD, Packer R, Goldwein J et al (2001) Intellectual outcome after reduced-dose radiation therapy plus adjuvant chemotherapy for medulloblastoma: a children’s cancer group study. J Clin Oncol 19(15):3470–3476PubMedGoogle Scholar
  31. 31.
    Oyharcabal-Bourden V, Kalifa C, Gentet JC et al (2005) Standard-risk medulloblastoma treated by adjuvant chemotherapy followed by reduced-dose craniospinal radiation therapy: a french society of pediatric oncology study. J Clin Oncol 23(21):4726–4734PubMedCrossRefGoogle Scholar
  32. 32.
    Kortmann RD, Timmermann B, Taylor RE et al (2003) Current and future strategies in radiotherapy of childhood low-grade glioma of the brain. Part II: treatment-related late toxicity. Strahlenther Onkol 179(9):585–597PubMedCrossRefGoogle Scholar
  33. 33.
    Freeman CR, Bourgouin PM, Sanford RA et al (1996) Long term survivors of childhood brain stem gliomas treated with hyperfractionated radiotherapy. Clinical characteristics and treatment related toxicities. The pediatric oncology group. Cancer 77(3):555–562PubMedCrossRefGoogle Scholar
  34. 34.
    Siffert J, Allen JC (2000) Late effects of therapy of thalamic and hypothalamic tumors in childhood: vascular, neurobehavioral and neoplastic. Pediatr Neurosurg 33(2):105–111PubMedCrossRefGoogle Scholar
  35. 35.
    Hoppe-Hirsch E, Brunet L, Laroussinie F et al (1995) Intellectual outcome in children with malignant tumors of the posterior fossa: influence of the field of irradiation and quality of surgery. Childs Nerv Syst 11(6):340–345, Discussion 345–346PubMedCrossRefGoogle Scholar
  36. 36.
    Mulhern RK, Horowitz ME, Kovnar EH et al (1989) Neurodevelopmental status of infants and young children treated for brain tumors with preirradiation chemotherapy. J Clin Oncol 7(11):1660–1666PubMedGoogle Scholar
  37. 37.
    Abdullah JM, Rahman ZA, Ariff AR et al (2004) Malignant rhabdoid tumour of the brain. Singapore Med J 45(6):286–288PubMedGoogle Scholar
  38. 38.
    Agranovich AL, Ang LC, Griebel RW et al (1992) Malignant rhabdoid tumor of the central nervous system with subarachnoid dissemination. Surg Neurol 37(5):410–414PubMedCrossRefGoogle Scholar
  39. 39.
    Ahmad FU, Suri A, Mahapatra AK et al (2005) Intraventricular rhabdoid tumor. Indian J Pediatr 72(8):693–696PubMedGoogle Scholar
  40. 40.
    Arslanoglu A, Aygun N, Tekhtani D et al (2004) Imaging findings of CNS atypical teratoid/rhabdoid tumors. AJNR Am J Neuroradiol 25(3):476–480PubMedGoogle Scholar
  41. 41.
    Ashraf R, Bentley RC, Awan AN et al (1997) Implantation metastasis of primary malignant rhabdoid tumor of the brain in an adult (one case report). Med Pediatr Oncol 28(3):223–227PubMedCrossRefGoogle Scholar
  42. 42.
    Bannykh S, Duncan C, Ogle E et al (2006) Atypical teratoid/rhabdoid tumor of the spinal canal. J Neurooncol 76(2):129–130PubMedCrossRefGoogle Scholar
  43. 43.
    Behring B, Bruck W, Goebel HH et al (1996) Immunohistochemistry of primary central nervous system malignant rhabdoid tumors: report of five cases and review of the literature. Acta Neuropathol (Berl) 91(6):578–586CrossRefGoogle Scholar
  44. 44.
    Bhattacharjee M, Hicks J, Langford L et al (1997) Central nervous system atypical teratoid/rhabdoid tumors of infancy and childhood. Ultrastruct Pathol 21(4):369–378PubMedGoogle Scholar
  45. 45.
    Biggs PJ, Garen PD, Powers JM et al (1987) Malignant rhabdoid tumor of the central nervous system. Hum Pathol 18(4):332–337PubMedGoogle Scholar
  46. 46.
    Booz MM, Koelma I, Unnikrishnan M (1996) Case report: primary malignant rhabdoid tumour of the brain. Clin Radiol 51(1):65–66PubMedCrossRefGoogle Scholar
  47. 47.
    Caldemeyer KS, Smith RR, Azzarelli B et al (1994) Primary central nervous system malignant rhabdoid tumor: CT and MR appearance simulates a primitive neuroectodermal tumor. Pediatr Neurosurg 21(4):232–236PubMedGoogle Scholar
  48. 48.
    Chi YW, Lee WH, Hwang RC et al (1989) Intracranial malignant rhabdoid tumor: report of one case. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 30(5):316–322PubMedGoogle Scholar
  49. 49.
    Chou SM, Anderson JS (1991) Primary CNS malignant rhabdoid tumor (MRT): report of two cases and review of literature. Clin Neuropathol 10(1):1–10PubMedGoogle Scholar
  50. 50.
    Chung YN, Wang KC, Shin SH et al (2002) Primary intracranial atypical teratoid/rhabdoid tumor in a child: a case report. J Korean Med Sci 17(5):723–726PubMedGoogle Scholar
  51. 51.
    Cossu A, Massarelli G, Manetto V et al (1993) Rhabdoid tumours of the central nervous system. Report of three cases with immunocytochemical and ultrastructural findings. Virchows Arch A Pathol Anat Histopathol 422(1):81–85PubMedCrossRefGoogle Scholar
  52. 52.
    Dang T, Vassilyadi M, Michaud J et al (2003) Atypical teratoid/rhabdoid tumors. Childs Nerv Syst 19(4):244–248PubMedGoogle Scholar
  53. 53.
    De Mot P, Demaerel P, Wilms G et al (2003) Imaging features of multifocal primary rhabdoid tumour of the central nervous system with meningeal and spinal metastases. Pediatr Radiol 33(4):275–277PubMedGoogle Scholar
  54. 54.
    Fenton LZ, Foreman NK (2003) Atypical teratoid/rhabdoid tumor of the central nervous system in children: an atypical series and review. Pediatr Radiol 33(8):554–558PubMedCrossRefGoogle Scholar
  55. 55.
    Fisher BJ, Siddiqui J, Macdonald D et al (1996) Malignant rhabdoid tumor of brain: an aggressive clinical entity. Can J␣Neurol Sci 23(4):257–263PubMedGoogle Scholar
  56. 56.
    Gandhi CD, Krieger MD, McComb JG (2004) Atypical teratoid/rhabdoid tumor: an unusual presentation. Neuroradiology 46(10):834–837PubMedCrossRefGoogle Scholar
  57. 57.
    Guler E, Varan A, Soylemezoglu F et al (2001) Extraneural metastasis in a child with atypical teratoid rhabdoid tumor of the central nervous system. J Neurooncol 54(1):53–56PubMedCrossRefGoogle Scholar
  58. 58.
    Hanna SL, Langston JW, Parham DM et al (1993) Primary malignant rhabdoid tumor of the brain: clinical, imaging, and pathologic findings. AJNR Am J Neuroradiol 14(1):107–115PubMedGoogle Scholar
  59. 59.
    Hasserjian RP, Folkerth RD, Scott RM et al (1995) Clinicopathologic and cytogenetic analysis of malignant rhabdoid tumor of the central nervous system. J Neurooncol 25(3):193–203PubMedCrossRefGoogle Scholar
  60. 60.
    Ho PS, Lee WH, Chen CY et al (1990) Primary malignant rhabdoid tumor of the brain: CT characteristics. J Comput Assist Tomogr 14(3):461–463PubMedCrossRefGoogle Scholar
  61. 61.
    Howes TL, Buatti JM, O’Dorisio MS et al (2005) Atypical teratoid/rhabdoid tumor case report: treatment with surgical␣excision, radiation therapy, and alternative medicines. J␣Neurooncol 72(1):85–88PubMedCrossRefGoogle Scholar
  62. 62.
    Howlett DC, King AP, Jarosz JM et al (1997) Imaging and pathological features of primary malignant rhabdoid tumours of the brain and spine. Neuroradiology 39(10):719–723PubMedCrossRefGoogle Scholar
  63. 63.
    Inenaga C, Toyoshima Y, Mori H et al (2003) A fourth ventricle atypical teratoid/rhabdoid tumor in an infant. Brain Tumor Pathol 20(2):47–52PubMedCrossRefGoogle Scholar
  64. 64.
    Izycka-Swieszewska E, Debiec-Rychter M, Wasag B et al (2003) A unique occurrence of a cerebral atypical teratoid/rhabdoid tumor in an infant and a spinal canal primitive neuroectodermal tumor in her father. J Neurooncol 61(3):219–225PubMedCrossRefGoogle Scholar
  65. 65.
    Jakate SM, Marsden HB, Ingram L (1988) Primary rhabdoid tumour of the brain. Virchows Arch A Pathol Anat Histopathol 412(4):393–397PubMedCrossRefGoogle Scholar
  66. 66.
    Kababri ME, Andre N, Carole C et al (2006) Atypical teratoid rhabdoid tumor in a child with neurofibromatosis 1. Pediatr Blood Cancer 46(2):267–268PubMedCrossRefGoogle Scholar
  67. 67.
    Korones DN, Meyers SP, Rubio A et al (1999) A 4-year-old girl with a ventriculoperitoneal shunt metastasis of a central nervous system atypical teratoid/rhabdoid tumor. Med Pediatr Oncol 32(5):389–391PubMedCrossRefGoogle Scholar
  68. 68.
    Kumar R (1999) Primary malignant rhabdoid tumours of brain, clinicoradiological findings of two cases. Neurol India 47(4):314–317PubMedGoogle Scholar
  69. 69.
    Lee YK, Choi CG, Lee JH (2004) Atypical teratoid/rhabdoid tumor of the cerebellum: report of two infantile cases. AJNR Am J Neuroradiol 25(3):481–483PubMedGoogle Scholar
  70. 70.
    Lutterbach J, Liegibel J, Koch D et al (2001) Atypical teratoid/rhabdoid tumors in adult patients: case report and review of the literature. J Neurooncol 52(1):49–56PubMedCrossRefGoogle Scholar
  71. 71.
    Manhoff DT, Rorke LB, Yachnis AT (1995) Primary intracranial atypical teratoid/rhabdoid tumor in a child with canavan disease. Pediatr Neurosurg 22(4):214–222PubMedCrossRefGoogle Scholar
  72. 72.
    Martinez-Lage JF, Nieto A, Sola J et al (1997) Primary malignant rhabdoid tumor of the cerebellum. Childs Nerv Syst 13(7):418–421PubMedCrossRefGoogle Scholar
  73. 73.
    Muller M, Hubbard SL, Provias J et al (1994) Malignant rhabdoid tumour of the pineal region. Can J Neurol Sci 21(3):273–277PubMedGoogle Scholar
  74. 74.
    Munoz A, Carrasco A, Munoz MJ et al (1995) Cranial rhabdoid tumor with marginal tumor cystic component and extraaxial extension. AJNR Am J Neuroradiol 16(8):1727–1728PubMedGoogle Scholar
  75. 75.
    Ogino S, Cohen ML, Abdul-Karim FW (1999) Atypical teratoid/rhabdoid tumor of the CNS: cytopathology and immunohistochemistry of insulin-like growth factor-II, insulin-like growth factor receptor type 1, cathepsin D, and ki-67. Mod Pathol 12(4):379–385PubMedGoogle Scholar
  76. 76.
    Pimentel J, Silva R, Pimentel T (2003) Primary malignant rhabdoid tumors of the central nervous system: considerations about two cases of adulthood presentation. J Neurooncol 61(2):121–126PubMedCrossRefGoogle Scholar
  77. 77.
    Proust F, Laquerriere A, Constantin B et al (1999) Simultaneous presentation of atypical teratoid/rhabdoid tumor in siblings. J Neurooncol 43(1):63–70PubMedCrossRefGoogle Scholar
  78. 78.
    Reinhardt D, Behnke-Mursch J, Weiss E et al (2000) Rhabdoid tumors of the central nervous system. Childs Nerv Syst 16(4):228–234PubMedCrossRefGoogle Scholar
  79. 79.
    Satoh H, Goishi J, Sogabe T et al (1993) Primary malignant rhabdoid tumor of the central nervous system: case report and review of the literature. Surg Neurol 40(5):429–434PubMedCrossRefGoogle Scholar
  80. 80.
    Sotelo-Avila C, Gonzalez-Crussi F, deMello D et al (1986) Renal and extrarenal rhabdoid tumors in children: a clinicopathologic study of 14 patients. Semin Diagn Pathol 3(2):151–163PubMedGoogle Scholar
  81. 81.
    Sugita Y, Takahashi Y, Hayashi I et al (1999) Pineal malignant rhabdoid tumor with chondroid formation in an adult. Pathol Int 49(12):1114–1118PubMedCrossRefGoogle Scholar
  82. 82.
    Suri A, Singh VP, Kale SS et al (2003) Multifocal intracranial rhabdoid tumor. Neurol India 51(2):297–298PubMedGoogle Scholar
  83. 83.
    Tekkok IH, Sav A (2005) Primary malignant rhabdoid tumor of the central nervous system – a comprehensive review. J␣Neurooncol 73(3):241–252PubMedCrossRefGoogle Scholar
  84. 84.
    Velasco ME, Brown JA, Kini J et al (1993) Primary congenital rhabdoid tumor of the brain with neoplastic hydranencephaly. Childs Nerv Syst 9(3):185–190, Discussion 190PubMedGoogle Scholar
  85. 85.
    Weeks DA, Malott RL, Zuppan CW et al (1994) Primitive cerebral tumor with rhabdoid features: a case of phenotypic rhabdoid tumor of the central nervous system. Ultrastruct Pathol 18(1–2):23–28PubMedGoogle Scholar
  86. 86.
    Wharton SB, Wardle C, Ironside JW et al (2003) Comparative genomic hybridization and pathological findings in atypical teratoid/rhabdoid tumour of the central nervous system. Neuropathol Appl Neurobiol 29(3):254–261PubMedCrossRefGoogle Scholar
  87. 87.
    Yoon CS, Chuang S, Jay V (2000) Primary malignant rhabdoid tumor of the brain: CT and MR findings. Yonsei Med J 41(1):8–16PubMedGoogle Scholar
  88. 88.
    Arrazola J, Pedrosa I, Mendez R et al (2000) Primary malignant rhabdoid tumour of the brain in an adult. Neuroradiology 42(5):363–367PubMedCrossRefGoogle Scholar
  89. 89.
    Chang HK, Kim JH (2001) Classical malignant rhabdoid tumor of central nervous system in 9-year-old korean. Yonsei Med J 42(1):142–146PubMedGoogle Scholar
  90. 90.
    Horn M, Schlote W, Lerch KD et al (1992) Malignant rhabdoid tumor: primary intracranial manifestation in an adult. Acta Neuropathol (Berl) 83(4):445–448CrossRefGoogle Scholar
  91. 91.
    Kawaguchi T, Kumabe T, Watanabe M et al (2004) Atypical teratoid/rhabdoid tumour with leptomeningeal dissemination in an adult. Acta Neurochir (Wien) 146(9):1033–1038, Discussion 1038CrossRefGoogle Scholar
  92. 92.
    Ronghe MD, Moss TH, Lowis SP (2004) Treatment of CNS malignant rhabdoid tumors. Pediatr Blood Cancer 42(3):254–260PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Sarah E. Squire
    • 1
  • Michael D. Chan
    • 2
  • Karen J. Marcus
    • 3
  1. 1.Brown Medical SchoolBrown UniversityProvidenceUSA
  2. 2.Department of Radiation OncologyTufts-New England Medical CenterBostonUSA
  3. 3.Department of Radiation OncologyChildren's Hospital Harvard UniversityBostonUSA

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