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      ERN GENTURIS tumour surveillance guidelines for individuals with neurofibromatosis type 1

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Summary

          Background

          Neurofibromatosis type 1 (NF1) is a multisystem genetic disorder, predisposing development of benign and malignant tumours. Given the oncogenic potential, long-term surveillance is important in patients with NF1. Proposals for NF1 care and its specific manifestations have been developed, but lack integration within routine care. This guideline aims to assimilate available information on NF1 associated tumours (based on evidence and/or expert opinion) to assist healthcare professionals in undertaking tumour surveillance of NF1 individuals.

          Methods

          By comprehensive literature review, performed March 18th 2020, guidelines were developed by a NF1 expert group and patient representatives, conversant with clinical care of the wide NF1 disease spectrum. We used a modified Delphi procedure to overcome issues of variability in recommendations for specific (national) health care settings, and to deal with recommendations based on indirect (scarce) evidence.

          Findings

          We defined proposals for personalised and targeted tumour management in NF1, ensuring appropriate care for those in need, whilst reducing unnecessary intervention. We also incorporated the tumour-related psychosocial and quality of life impact of NF1.

          Interpretation

          The guideline reflects the current care for NF1 in Europe. They are not meant to be prescriptive and may be adjusted to local available resources at the treating centre, both within and outside EU countries.

          Funding

          This guideline has been supported by the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS). ERN GENTURIS is funded by the doi 10.13039/501100000780, European Union; . DGE is supported by the Manchester doi 10.13039/100015250, NIHR; doi 10.13039/100014461, Biomedical Research Centre; (IS-BRC-1215-20007).

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          Most cited references121

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          Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline.

          The aim was to formulate clinical practice guidelines for pheochromocytoma and paraganglioma (PPGL).
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            Consensus development methods, and their use in clinical guideline development.

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              Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases.

              A review was done of 120 cases of malignant peripheral nerve sheath tumor (MPNST) seen during a 71-year period. Of the 120 patients, 52 were males and 68 were females with a mean age at diagnosis of 35.3 years; 12 patients were younger than 20 years. The series included 62 (52%) patients with neurofibromatosis, 13 (11%) with postradiation sarcomas, and 19 (16%) with metaplastic foci. The incidence of MPNST arising in neurofibromatosis was 4.6% in the current series and 0.001% in the general clinic population. Tumors greater than 5 cm and the presence of neurofibromatosis adversely affected the prognosis (P less than 0.05). When both features were present, survival was greatly decreased. Patients with tumor in the extremities did better than those with head or neck lesions. Metaplastic foci or previous radiation at the tumor site did not alter the prognosis. Each tumor was graded 1 to 4 on the basis of cellularity, pleomorphism, mitotic index, and necrosis. No significant correlation was noted between survival and either grade or mitotic rate. Survival was improved when total rather than subtotal resection was done. This was most marked in patients with a small lesion, which may reflect the difficulty in adequately excising large tumors. Adjuvant radiation or chemotherapy did not appear to affect survival. The MPNST is an aggressive uncommon neoplasm, and large tumor size, the presence of neurofibromatosis, and total resection are the most important prognostic indicators.
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                Author and article information

                Contributors
                Journal
                eClinicalMedicine
                EClinicalMedicine
                eClinicalMedicine
                Elsevier
                2589-5370
                13 January 2023
                February 2023
                13 January 2023
                : 56
                : 101818
                Affiliations
                [a ]Laboratory for Neurofibromatosis Research, Department of Human Genetics, University of Leuven, KU Leuven, Belgium
                [b ]Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, MAHSC, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
                [c ]Clinical Genetics Department, Hospital Germans Trias I Pujol, Barcelona, Spain
                [d ]Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
                [e ]Neurofibromatosis Centre, Department of Neurology, Guy's & St Thomas' NHS Foundation Trust, London, UK
                [f ]Sant Joan de Déu, Barcelona Children's Hospital, Barcelona, Spain
                [g ]Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria
                [h ]NF Kinder, Austria
                [i ]University of Turku and Turku University Hospital, Turku, Finland
                [j ]Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Sweden
                [k ]Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
                [l ]Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
                [m ]University Hospital Leuven, Department of Human Genetics, University of Leuven, KU Leuven, Belgium
                [n ]ENCORE-NF1 Expertise Center, ErasmusMC-Sophia, Rotterdam, the Netherlands
                Author notes
                []Corresponding author. Department General Pediatrics, ErasmusMC-Sophia, Room Sp 1549, Dr Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands. r.oostenbrink@ 123456erasmusmc.nl
                [o]

                Full Member of the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS).

                [p]

                Affiliated Partner of the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS).

                [q]

                Supporting partner of the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS).

                [r]

                Patient representative of the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS).

                Article
                S2589-5370(22)00547-8 101818
                10.1016/j.eclinm.2022.101818
                9845795
                36684394
                549ed271-e952-4daa-8fb2-7c5a33651942
                © 2022 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 19 July 2022
                : 16 December 2022
                : 22 December 2022
                Categories
                Review

                guideline,neurofibromatosis type 1,tumour predisposing syndrome,management

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